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"billed_charge": 1254.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.98, "providers": [{ "billed_charge": 341.88, "npi": [1306940689] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.48, "providers": [{ "billed_charge": 888.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 180.96, "providers": [{ "billed_charge": 1085.76, "npi": [1306940689] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": 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"billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.87, "providers": [{ "billed_charge": 166.68, "npi": [1306940689] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.78, "providers": [{ "billed_charge": 167.22, "npi": [1306940689] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.76, "providers": [{ "billed_charge": 466.08, "npi": [1306940689] } ] } ] }, { "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 709.56, "providers": [{ "billed_charge": 7008.00, "npi": [1740265347] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.24, "providers": [{ "billed_charge": 858.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.96, "providers": [{ "billed_charge": 77.64, "npi": [1306940689] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.48, "providers": [{ "billed_charge": 104.88, "npi": [1306940689] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.20, "providers": [{ "billed_charge": 564.00, "npi": [1740265347] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 62.58, "providers": [{ "billed_charge": 375.48, "npi": [1306940689] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.91, "providers": [{ "billed_charge": 77.43, "npi": [1306940689] } ] } ] }, { "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.46, "providers": [{ "billed_charge": 660.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.59, "providers": [{ "billed_charge": 621.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 306.68, "providers": [{ "billed_charge": 1840.08, "npi": [1306940689] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1234.80, "providers": [{ "billed_charge": 12348.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 529.20, "providers": [{ "billed_charge": 3175.20, "npi": [1306940689] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 165.88, "providers": [{ "billed_charge": 1040.00, "npi": [1740265347] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.17, "providers": [{ "billed_charge": 559.02, "npi": [1306940689] } ] } ] } ] }, { "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.74, "providers": [{ "billed_charge": 520.80, "npi": [1427827948] } ] }, { "allowed_amount": 59.29, "providers": [{ "billed_charge": 358.05, "npi": [1518756923] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.69, "providers": [{ "billed_charge": 489.51, "npi": [1306940689] } ] } ] }, { "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1081.42, "providers": [{ "billed_charge": 9730.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.68, "providers": [{ "billed_charge": 224.00, "npi": [1740265347] } ] } ] } ] }, { "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": "203035983" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28728.00, "providers": [{ "billed_charge": 440814.96, "npi": [1922049782] } ] } ] } ] }, { "name": "RBC SED RATE, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85652", "description": "SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.25, "providers": [{ "billed_charge": 405.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.49, "providers": [{ "billed_charge": 462.00, "npi": [1740265347] } ] } ] } ] }, { "name": "T CELLS, TOTAL COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86359", "description": "T CELLS; TOTAL COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 547.23, "providers": [{ "billed_charge": 5452.00, "npi": [1740265347] } ] } ] } ] }, { "name": "T CELL, ABSOLUTE COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86361", "description": "T CELLS; ABSOLUTE CD4 COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 388.31, "providers": [{ "billed_charge": 5481.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.84, "providers": [{ "billed_charge": 168.00, "npi": [1740265347] } ] } ] } ] }, { "name": "TREPONEMA PALLIDUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86780", "description": "ANTIBODY; TREPONEMA PALLIDUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 172.12, "providers": [{ "billed_charge": 1690.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "736017987" }, "service_code": ["71"], "billing_class": "professional", "payments": [{ "allowed_amount": 97.82, "providers": [{ "billed_charge": 125.64, "npi": [1518197524] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 249.90, "providers": [{ "billed_charge": 2205.00, "npi": [1740265347] } ] } ] } ] }, { "name": "RBC ANTIBODY SCREEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86850", "description": "ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.78, "providers": [{ "billed_charge": 120.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 76.76, "providers": [{ "billed_charge": 912.00, "npi": [1740265347] } ] } ] } ] }, { "name": "URINE BACTERIA 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"payments": [{ "allowed_amount": 316.35, "providers": [{ "billed_charge": 765.00, "npi": [1811987712] } ] } ] } ] }, { "name": "CANDIDA, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87481", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812532457" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 300.00, "npi": [1699744144] } ] } ] } ] }, { "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": "731383996" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 140.36, "npi": [1326495433] } ] } ] }, { "tin": { "type": "ein", "value": "736017987" }, "service_code": ["71"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 70.86, "npi": [1518197524] } ] } ] }, { "tin": { "type": "ein", "value": "20619423" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 649.35, "providers": [{ "billed_charge": 2664.00, "npi": [1619994522] } ] } ] } ] }, { "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 GONORRHOEAE, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731383996" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 140.36, "npi": [1326495433] } ] } ] }, { "tin": { "type": "ein", "value": "736017987" }, "service_code": ["71"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 70.86, "npi": [1518197524] } ] } ] }, { "tin": { "type": "ein", "value": "20619423" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 649.35, "providers": [{ "billed_charge": 2664.00, "npi": [1619994522] } ] } ] } ] }, { "name": "HPV HIGH-RISK TYPES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87624", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "730779408" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.40, "providers": [{ "billed_charge": 3444.00, "npi": [1043271901] } ] } ] }, { "tin": { "type": "ein", "value": 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"billed_charge": 403000.00, "npi": [1356110407] } ] } ] }, { "tin": { "type": "ein", "value": "736061037" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 45446.24, "providers": [{ "billed_charge": 50371.16, "npi": [1770525883] } ] } ] }, { "tin": { "type": "ein", "value": "730717399" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6300.00, "providers": [{ "billed_charge": 6300.00, "npi": [1891735866] } ] } ] }, { "tin": { "type": "ein", "value": "731489396" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 198816.45, "providers": [{ "billed_charge": 199959.22, "npi": [1093760456] } ] } ] }, { "tin": { "type": "ein", "value": "731038915" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1072052.84, "providers": [{ "billed_charge": 1236300.00, "npi": [1740207646] } ] }, { "allowed_amount": 1302600.00, "providers": [{ "billed_charge": 1302600.00, "npi": [1457378150] } ] } ] } ] }, { "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": "421674975" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 854.26, "providers": [{ "billed_charge": 1670.00, "npi": [1306946371] } ] } ] }, { "tin": { "type": "ein", "value": "205005608" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8295.56, "providers": [{ "billed_charge": 12170.00, "npi": [1073549549] } ] } ] }, { "tin": { "type": "ein", "value": "731038915" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 31607.62, "providers": [{ "billed_charge": 33300.00, "npi": [1457378150] } ] }, { "allowed_amount": 28651.70, "providers": [{ "billed_charge": 36900.00, "npi": [1740207646] } ] } ] } ] }, { "name": "AMB SERVICE BLS EMERGENCY TR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "421674975" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 57941.18, "providers": [{ "billed_charge": 64860.00, "npi": [1306946371] } ] } ] }, { "tin": { "type": "ein", "value": "730657693" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1366.82, "providers": [{ "billed_charge": 2635.54, "npi": [1023603727] } ] } ] }, { "tin": { "type": "ein", "value": "736005359" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 29900.00, "providers": [{ "billed_charge": 29900.00, "npi": [1356110407] } ] } ] }, { "tin": { "type": "ein", "value": "330995734" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 69707.82, "providers": [{ "billed_charge": 71400.00, "npi": [1235173089] } ] } ] }, { "tin": { "type": "ein", "value": "730968231" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 12421.89, "providers": [{ "billed_charge": 13500.00, "npi": [1104818434] } ] } ] }, { "tin": { "type": "ein", "value": "730717399" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16800.00, "providers": [{ "billed_charge": 16800.00, "npi": [1891735866] } ] } ] }, { "tin": { "type": "ein", "value": "736061037" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 42371.42, "providers": [{ "billed_charge": 46962.52, "npi": [1770525883] } ] } ] }, { "tin": { "type": "ein", "value": "731489396" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 13802.10, "providers": [{ "billed_charge": 13802.10, "npi": [1093760456] } ] } ] }, { "tin": { "type": "ein", "value": "731038915" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 307895.92, "providers": [{ "billed_charge": 348400.00, "npi": [1740207646] } ] }, { "allowed_amount": 392600.00, "providers": [{ "billed_charge": 392600.00, "npi": [1457378150] } ] } ] } ] }, { "name": "ADVNCED LIFE SUPPORT LEVEL 2", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0433", "description": "ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731038915" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1300.00, "providers": [{ "billed_charge": 1300.00, "npi": [1457378150] } ] } ] } ] }, { "name": "AMB RSPN&TREATMENT NO TRNSPT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0998", "description": "AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "421674975" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23760.00, "providers": [{ "billed_charge": 33000.00, "npi": [1306946371] } ] } ] } ] }, { "name": "DISPBL RX DEL SYS RATE 50 ML", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4305", "description": "DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "991458508" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.98, "providers": [{ "billed_charge": 240.00, "npi": [1558507962] } ] }, { "allowed_amount": 719.04, "providers": [{ "billed_charge": 6900.00, "npi": [1558507962] } ] } ] }, { "tin": { "type": "ein", "value": "463252169" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.90, "providers": [{ "billed_charge": 1900.00, "npi": [1558507962] } ] }, { "allowed_amount": 104.86, "providers": [{ "billed_charge": 2660.00, "npi": [1558507962] } ] } ] } ] }, { "name": "TUBING W/INTGR HEAT ELEM W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4604", "description": "TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 325.36, "providers": [{ "billed_charge": 1141.00, "npi": [1234567893] } ] } ] } ] }, { "name": "NASL INTERFCE POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "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": 72.87, "providers": [{ "billed_charge": 330.00, "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": 150.36, "providers": [{ "billed_charge": 679.80, "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 527.70, "providers": [{ "billed_charge": 1360.89, "npi": [1234567893] } ] } ] } ] }, { "name": "CRTCHES UNDARM OTH THAN WOOD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0114", "description": "CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 479.09, "providers": [{ "billed_charge": 612.60, "npi": [1234567893] } ] } ] } ] }, { "name": "WALKER FOLD WHEELED ADJUSTBL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0143", "description": "WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 417.90, "providers": [{ "billed_charge": 1070.00, "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1060.80, "providers": [{ "billed_charge": 6035.28, "npi": [1234567893] } ] } ] } ] }, { "name": "HOME VENT TYPE USD NON-INVAS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0466", "description": "HOME VENTILATOR, ANY TYPE, USED WITH NONINVASIVE INTERFACE, (E.G., MASK, CHEST SHELL)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1900.00, "providers": [{ "billed_charge": 7551.04, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 548.36, "providers": [{ "billed_charge": 1863.84, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 526.35, "providers": [{ "billed_charge": 9621.92, "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8700.00, "providers": [{ "billed_charge": 68379.36, "npi": [1234567893] } ] } ] } ] }, { "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": 872.29, "providers": [{ "billed_charge": 3990.00, "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7382.88, "providers": [{ "billed_charge": 31596.87, "npi": [1234567893] } ] } ] } ] }, { "name": "PROSTATE CANCER SCREENING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0103", "description": "PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 38.64, "providers": [{ "billed_charge": 221.88, "npi": [1306940689] } ] } ] } ] }, { "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": "731357965" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.80, "providers": [{ "billed_charge": 160.00, "npi": [1871378497] } ] }, { "allowed_amount": 44.85, "providers": [{ "billed_charge": 120.00, "npi": [1871378497] } ] } ] }, { "tin": { "type": "ein", "value": "270919068" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.82, "providers": [{ "billed_charge": 120.00, "npi": [1164403986] } ] } ] }, { "tin": { "type": "ein", "value": "834439721" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 463.45, "providers": [{ "billed_charge": 1026.00, "npi": [1003256819] } ] } ] }, { "tin": { "type": "ein", "value": "760825755" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 313.88, "providers": [{ "billed_charge": 742.00, "npi": [1376353532] } ] } ] }, { "tin": { "type": "ein", "value": "850612245" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.30, "providers": [{ "billed_charge": 418.60, "npi": [1083830715] } ] } ] } ] }, { "name": "STEREO X-R GUID LOC TRG VOL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G6002", "description": "STEREOSCOPIC X-RAY GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR THE DELIVERY OF RADIATION THERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "863284696" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.95, "providers": [{ "billed_charge": 803.00, "npi": [1144580853] } ] } ] } ] }, { "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": "823552173" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7425.00, "providers": [{ "billed_charge": 29700.00, "npi": [1750149357] } ] } ] }, { "tin": { "type": "ein", "value": "932572939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 168675.00, "providers": [{ "billed_charge": 674700.00, "npi": [1790120483] } ] } ] }, { "tin": { "type": "ein", "value": "853005640" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17820.25, "providers": [{ "billed_charge": 71281.00, "npi": [1053919423] } ] } ] }, { "tin": { "type": "ein", "value": "921734587" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 562.50, "providers": [{ "billed_charge": 2250.00, "npi": [1033140744] } ] } ] } ] }, { "name": "ORAL MEDADMIN DIR OBSERV", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0033", "description": "ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "736045246" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4977.00, "providers": [{ "billed_charge": 16590.00, "npi": [1235146036] } ] } ] } ] }, { "name": "MENTAL HLTH PART HOSP TX <24", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0035", "description": "MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823552173" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10800.00, "providers": [{ "billed_charge": 43200.00, "npi": [1750149357] } ] } ] }, { "tin": { "type": "ein", "value": "932572939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 682075.00, "providers": [{ "billed_charge": 2728300.00, "npi": [1790120483] } ] } ] }, { "tin": { "type": "ein", "value": "853005640" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 20973.75, "providers": [{ "billed_charge": 83895.00, "npi": [1053919423] } ] } ] } ] }, { "name": "INJ AMPCLLN SODIM/SULBACTAM-", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0295", "description": "INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 G", "allowed_amounts": [{ "tin": { "type": "ein", "value": "991458508" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 37.68, "providers": [{ "billed_charge": 7200.00, "npi": [1558507962] } ] } ] } ] }, { "name": "BPN/NLX O >6 MG BUT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0574", "description": "BUPRENORPHINE/NALOXONE, ORAL, GREATER THAN 6 MG, BUT LESS THAN OR EQUAL TO 10 MG BUPRENORPHINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "736045246" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3532.50, "providers": [{ "billed_charge": 11775.00, "npi": [1235146036] } ] } ] } ] }, { "name": "INJECTION DAPTOMYCIN 1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0878", "description": "INJECTION, DAPTOMYCIN, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "991458508" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.00, "providers": [{ "billed_charge": 4757.85, "npi": [1558507962] } ] } ] }, { "tin": { "type": "ein", "value": "463252169" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 738.00, "providers": [{ "billed_charge": 21894.00, "npi": [1558507962] } ] } ] } ] }, { "name": "INJ DEXMETH SODM PHOSHA 1MG", 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"billing_class": "professional", "payments": [{ "allowed_amount": 57653.75, "providers": [{ "billed_charge": 230615.00, "npi": [1053919423] } ] } ] } ] }, { "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": "991458508" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1452.50, "providers": [{ "billed_charge": 5810.00, "npi": [1558507962] } ] }, { "allowed_amount": 27.50, "providers": [{ "billed_charge": 110.00, "npi": [1558507962] } ] } ] }, { "tin": { "type": "ein", "value": "463252169" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5310.00, "providers": [{ "billed_charge": 21240.00, "npi": [1558507962] } ] }, { "allowed_amount": 3835.00, "providers": [{ "billed_charge": 15340.00, "npi": [1558507962] } ] } ] } ] }, { "name": "HIT ANTIBIOTIC/ANTIFUNGAL; Q", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9501", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 12 HOURS; ADMINISTRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463252169" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 930.00, "providers": [{ "billed_charge": 3720.00, "npi": [1558507962] } ] } ] } ] }, { "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": "991458508" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.00, "providers": [{ "billed_charge": 360.00, "npi": [1558507962] } ] } ] } ] } ] }