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"tin": { "type": "ein", "value": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 131.86, "providers": [{ "billed_charge": 3838.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 63.58, "providers": [{ "billed_charge": 264.00, "npi": [1234567893] } ] } ] } ] }, { "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": "621323090" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7262.34, "providers": [{ "billed_charge": 35820.00, "npi": [1518930635] } ] } ] }, { "tin": { "type": "ein", "value": "592851389" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3172.53, "providers": [{ "billed_charge": 123648.00, "npi": [1003928847] } ] } ] }, { "tin": { "type": "ein", "value": "42625090" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8024.00, "providers": [{ "billed_charge": 70656.00, "npi": [1477665222] } ] }, { "allowed_amount": 11460.00, "providers": [{ "billed_charge": 220800.00, "npi": [1922100304] } ] }, { "allowed_amount": 1802.00, "providers": [{ "billed_charge": 17664.00, "npi": [1255603833] } ] }, { "allowed_amount": 14436.26, "providers": [{ "billed_charge": 326784.00, "npi": [1982716742] } ] } ] } ] }, { "name": "BILIRUBIN, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82247", "description": "BILIRUBIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.22, "providers": [{ "billed_charge": 264.00, "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 213.12, "providers": [{ "billed_charge": 1254.00, "npi": [1497859052] } ] } ] } ] }, { "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 155.47, "providers": [{ "billed_charge": 2150.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.19, "providers": [{ "billed_charge": 655.28, "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 380.10, "providers": [{ "billed_charge": 2058.00, "npi": [1497859052] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 229.04, "providers": [{ "billed_charge": 2338.00, "npi": [1497859052] } ] } ] } ] }, { "name": "GLUCOSE OTHER FLUID", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82945", "description": "GLUCOSE, BODY FLUID, OTHER THAN BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.34, "providers": [{ "billed_charge": 176.00, "npi": [1234567893] } ] } ] } ] }, { "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": "630695975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.88, "providers": [{ "billed_charge": 88.00, "npi": [1710152582] } ] } ] }, { "tin": { "type": "ein", "value": "630727804" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.91, "providers": [{ "billed_charge": 69.18, "npi": [1992710743] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.94, "providers": [{ "billed_charge": 37.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "272596795" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.88, "providers": [{ "billed_charge": 60.00, "npi": [1023112307] } ] } ] } ] }, { "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": "721382190" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.39, "providers": [{ "billed_charge": 2.39, "npi": [1558124768] } ] } ] }, { "tin": { "type": "ein", "value": "630307951" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.95, "providers": [{ "billed_charge": 25.00, "npi": [1356343271] } ] } ] }, { "tin": { "type": "ein", "value": "630737968" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.24, "providers": [{ "billed_charge": 312.00, "npi": [1629759501] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.37, "providers": [{ "billed_charge": 374.00, "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": "630695975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.86, "providers": [{ "billed_charge": 39.50, "npi": [1710152582] } ] } ] }, { "tin": { "type": "ein", "value": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 966.95, "providers": [{ "billed_charge": 9960.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "630737968" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.46, "providers": [{ "billed_charge": 286.00, "npi": [1629759501] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 382.44, "providers": [{ "billed_charge": 3871.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF URINE HEMOGLOBIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83069", "description": "HEMOGLOBIN; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.56, "providers": [{ "billed_charge": 220.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.12, "providers": [{ "billed_charge": 1680.00, "npi": [1497859052] } ] } ] } ] }, { "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.92, "providers": [{ "billed_charge": 1088.00, "npi": [1497859052] } ] } ] } ] }, { "name": "ASSAY PH BODY FLUID NOS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83986", "description": "PH; BODY FLUID, NOT OTHERWISE SPECIFIED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.80, "providers": [{ "billed_charge": 140.00, "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": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.14, "providers": [{ "billed_charge": 73.56, "npi": [1234567893] } ] }, { "allowed_amount": 27.60, "providers": [{ "billed_charge": 105.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.48, "providers": [{ "billed_charge": 165.00, "npi": [1234567893] } ] } ] } ] }, { "name": "SPECTROPHOTOMETRY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84311", "description": "SPECTROPHOTOMETRY, ANALYTE NOT ELSEWHERE SPECIFIED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 255.15, "providers": [{ "billed_charge": 1008.00, "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 465.26, "providers": [{ "billed_charge": 6493.00, "npi": [1497859052] } ] } ] } ] }, { "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1491.84, "providers": [{ "billed_charge": 15466.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 117.60, "providers": [{ "billed_charge": 540.00, "npi": [1234567893] } ] } ] } ] }, { "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": "721382190" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.20, "providers": [{ "billed_charge": 31.76, "npi": [1558124768] } ] }, { "allowed_amount": 23.10, "providers": [{ "billed_charge": 55.58, "npi": [1023876653] } ] }, { "allowed_amount": 6.60, "providers": [{ "billed_charge": 15.88, "npi": [1023876653] } ] }, { "allowed_amount": 52.80, "providers": [{ "billed_charge": 127.04, "npi": [1558124768] } ] } ] }, { "tin": { "type": "ein", "value": "630897317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.59, "providers": [{ "billed_charge": 1085.00, "npi": [1487186094] } ] } ] }, { "tin": { "type": "ein", "value": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1211.60, "providers": [{ "billed_charge": 12740.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "631137578" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.16, "providers": [{ "billed_charge": 40.00, "npi": [1609890474] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.80, "providers": [{ "billed_charge": 93.24, "npi": [1234567893] } ] }, { "allowed_amount": 229.51, "providers": [{ "billed_charge": 1439.00, "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.88, "providers": [{ "billed_charge": 1848.00, "npi": [1497859052] } ] } ] } ] }, { "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 143.06, "providers": [{ "billed_charge": 1541.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.08, "providers": [{ "billed_charge": 228.00, "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 564.96, "providers": [{ "billed_charge": 4884.00, "npi": [1497859052] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.12, "providers": [{ "billed_charge": 60.00, "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": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1098.20, "providers": [{ "billed_charge": 5548.00, "npi": [1497859052] } ] } ] } ] }, { "name": "CHYLMD TRACH, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87491", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "630477348" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 757.98, "providers": [{ "billed_charge": 2592.00, "npi": [1497859052] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 87.75, "providers": [{ "billed_charge": 250.00, "npi": [1234567893] } ] }, { "allowed_amount": 35.16, "providers": [{ "billed_charge": 390.00, "npi": [1234567893] } ] } ] } ] }, { "name": "N.GONORRHOEAE, DNA, AMP PROB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87591", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA 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"billing_class": "professional", "payments": [{ "allowed_amount": 33595.40, "providers": [{ "billed_charge": 69977.10, "npi": [1033782560] } ] } ] }, { "tin": { "type": "ein", "value": "636001318" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 137543.52, "providers": [{ "billed_charge": 250560.00, "npi": [1407816713] } ] } ] }, { "tin": { "type": "ein", "value": "453639743" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 734.64, "providers": [{ "billed_charge": 900.00, "npi": [1477830164] } ] } ] }, { "tin": { "type": "ein", "value": "721397961" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4519.02, "providers": [{ "billed_charge": 8800.00, "npi": [1548246010] } ] } ] }, { "tin": { "type": "ein", "value": "630779256" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9881.00, "providers": [{ "billed_charge": 25750.00, "npi": [1194737460] } ] } ] }, { "tin": { "type": "ein", "value": "631149220" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 17162.16, "providers": [{ "billed_charge": 31175.00, "npi": [1942277124] } ] } ] }, { "tin": { "type": "ein", "value": "463413109" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 790.48, "providers": [{ "billed_charge": 2000.00, "npi": [1063847085] } ] } ] }, { "tin": { "type": "ein", "value": "263644474" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16204.84, "providers": [{ "billed_charge": 32882.00, "npi": [1215160916] } ] } ] } ] }, { "name": "AMB SERVICE BLS NONEMERG TRA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0428", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)", "allowed_amounts": [{ "tin": { "type": "ein", "value": 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"payments": [{ "allowed_amount": 105221.80, "providers": [{ "billed_charge": 205953.00, "npi": [1851917504] } ] } ] }, { "tin": { "type": "ein", "value": "465007345" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 336.10, "providers": [{ "billed_charge": 1086.52, "npi": [1891240859] } ] } ] }, { "tin": { "type": "ein", "value": "630737822" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7058.10, "providers": [{ "billed_charge": 12075.00, "npi": [1851471932] } ] } ] }, { "tin": { "type": "ein", "value": "631130184" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3994.08, "providers": [{ "billed_charge": 8319.36, "npi": [1558457176] } ] } ] }, { "tin": { "type": "ein", "value": "630725492" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11316.56, "providers": [{ "billed_charge": 28900.00, "npi": [1386710515] } ] } ] }, { "tin": { "type": "ein", "value": "832156832" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6526.74, "providers": [{ "billed_charge": 27140.50, "npi": [1770059800] } ] } ] }, { "tin": { "type": "ein", "value": "631058881" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1997.04, "providers": [{ "billed_charge": 4012.08, "npi": [1538236211] } ] } ] }, { "tin": { "type": "ein", "value": "631150208" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 24438.20, "providers": [{ "billed_charge": 115200.00, "npi": [1831206713] } ] } ] }, { "tin": { "type": "ein", "value": "861281752" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7655.32, "providers": [{ "billed_charge": 15945.44, "npi": [1033782560] } ] } ] }, { "tin": { "type": "ein", "value": "636001318" }, "service_code": ["41"], "billing_class": 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"billing_code": "A7034", "description": "NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1236.94, "providers": [{ "billed_charge": 7639.74, "npi": [1234567893] } ] } ] } ] }, { "name": "HEADGEAR USED W/POS ARWAY PR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7035", "description": "HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1222.43, "providers": [{ "billed_charge": 5496.43, "npi": [1234567893] } ] } ] } ] }, { "name": "TUBING USED W/POS ARWAY PRES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7037", "description": "TUBING USED 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SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS DETERMINATIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.03, "providers": [{ "billed_charge": 30.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ANL WELLNES VST PERSNL PPS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0438", "description": "ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "850770765" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7386.32, "providers": [{ "billed_charge": 11600.00, "npi": [1134512072] } ] } ] } ] }, { "name": "FQHC VISIT ESTABLISHED PATIE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0467", "description": "FEDERALLY QUALIFIED HEALTH CENTER 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1225.00, "npi": [1548298045] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1814.00, "providers": [{ "billed_charge": 3624.30, "npi": [1234567893] } ] } ] } ] }, { "name": "RT D 3/> S TX AR CSTM BLK;6-", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G6012", "description": "RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 939.30, "providers": [{ "billed_charge": 6100.00, "npi": [1234567893] } ] } ] } ] }, { "name": "RT D 3/> S TX AR CSTM BLK;11", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G6013", "description": "RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5849.70, "providers": [{ "billed_charge": 38130.00, "npi": [1234567893] } ] } ] } ] }, { "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": "631185834" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10537.20, "providers": [{ "billed_charge": 67320.00, "npi": [1225591878] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 28391.90, "providers": [{ "billed_charge": 181390.00, "npi": [1234567893] } ] } ] } ] }, { "name": "INTRA-F LOC&TRCK TRGT/PT M E", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G6017", "description": "INTRA-FRACTION LOCALIZATION AND TRACKING OF TARGET OR PATIENT MOTION DURING DELIVERY OF RADIATION TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 567.54, "providers": [{ "billed_charge": 2310.00, "npi": [1234567893] } ] } ] } ] }, { "name": "BEHAVIORAL HEALTH CNSL&TX-15", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0004", "description": "BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "630700401" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 1419.60, "providers": [{ "billed_charge": 4732.00, "npi": [1992237721] } ] } ] } ] }, { "name": "INJECTION, AFLIBERCEPT, 1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0178", "description": "INJECTION, AFLIBERCEPT, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3171.80, "providers": [{ "billed_charge": 4500.00, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["11", "72"], "billing_class": "professional", "payments": [{ "allowed_amount": 0.48, "providers": [{ "billed_charge": 4.00, "npi": [1234567893] } ] }, { "allowed_amount": 19.83, "providers": [{ "billed_charge": 211.80, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "823581568" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.62, "providers": [{ "billed_charge": 126.00, "npi": [1124591177] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 126.96, "providers": [{ "billed_charge": 1107.20, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "823581568" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.80, "providers": [{ "billed_charge": 80.00, "npi": [1124591177] } ] } ] } ] }, { "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": "721382190" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.04, "providers": [{ "billed_charge": 2.20, "npi": [1558124768] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "72"], "billing_class": "professional", "payments": [{ "allowed_amount": 0.24, "providers": [{ "billed_charge": 4.00, "npi": [1234567893] } ] }, { "allowed_amount": 29.96, "providers": [{ "billed_charge": 4120.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "270851352" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.07, "providers": [{ "billed_charge": 24.00, "npi": [1073247565] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["11", "72"], "billing_class": "professional", "payments": [{ "allowed_amount": 0.35, "providers": [{ "billed_charge": 4.00, "npi": [1234567893] } ] }, { "allowed_amount": 65.83, "providers": [{ "billed_charge": 2285.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "270851352" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.80, "providers": [{ "billed_charge": 160.00, "npi": [1710603659] } ] } ] }, { "tin": { "type": "ein", "value": "823581568" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.00, "providers": [{ "billed_charge": 21.00, "npi": [1124591177] } ] } ] } ] }, { "name": "INJ MICAFUNGIN SODIUM 1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2248", "description": "INJECTION, MICAFUNGIN SODIUM, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.00, "providers": [{ "billed_charge": 2010.00, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ ORPHENADRINE CITRATE TO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2360", "description": "INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 217.87, "providers": [{ "billed_charge": 475.00, "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": 49.53, "providers": [{ "billed_charge": 580.00, "npi": [1234567893] } ] } ] } ] }, { "name": "STANDARD WHEELCHAIR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "K0001", "description": "STANDARD WHEELCHAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2093.62, "providers": [{ "billed_charge": 10663.52, "npi": [1234567893] } ] } ] } ] }, { "name": "HIT ANTIBIOTIC/ANTIFUNGAL; Q", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9500", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 24 HOURS; ADMINISTRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4230.00, "providers": [{ "billed_charge": 14100.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HIT ABX ANTIVIRL/ANTIFUNGAL;", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9502", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 8 HOURS, ADMINISTRAT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1025.10, "providers": [{ "billed_charge": 3417.00, "npi": [1234567893] } ] } ] } ] } ] }