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"providers": [{ "billed_charge": 22345.62, "npi": [1234567893] } ] } ] } ] }, { "name": "CUSHN NASAL MASK INTF REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7032", "description": "CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.76, "providers": [{ "billed_charge": 3372.89, "npi": [1234567893] } ] } ] } ] }, { "name": "PILLW NASL CANNULA TYPE INTF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7033", "description": "PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 267.52, "providers": [{ "billed_charge": 1823.93, "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": "882022864" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 393.75, "providers": [{ "billed_charge": 393.75, "npi": [1811206741] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 582.68, "providers": [{ "billed_charge": 4896.01, "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": "882022864" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 304.16, "providers": [{ "billed_charge": 304.16, "npi": [1811206741] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 634.68, "providers": [{ "billed_charge": 3715.40, "npi": [1234567893] } ] } ] } ] }, { "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": 198.27, "providers": [{ "billed_charge": 1026.85, "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": "882022864" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 742.52, "providers": [{ "billed_charge": 1134.60, "npi": [1811206741] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 614.95, "providers": [{ "billed_charge": 4727.53, "npi": [1234567893] } ] } ] } ] }, { "name": "WATR CHAMB HUMDIFIR USED W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7046", "description": "WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.73, "providers": [{ "billed_charge": 1427.60, "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": 1607.20, "providers": [{ "billed_charge": 6971.93, "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": "882022864" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1437.87, "providers": [{ "billed_charge": 1437.87, "npi": [1811206741] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3829.82, "providers": [{ "billed_charge": 15386.50, "npi": [1234567893] } ] } ] } ] }, { "name": "NEBULIZER WITH COMPRESSOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0570", "description": "NEBULIZER, WITH COMPRESSOR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 345.62, "providers": [{ "billed_charge": 2544.72, "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": "882022864" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11530.96, "providers": [{ "billed_charge": 14200.00, "npi": [1811206741] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4322.85, "providers": [{ "billed_charge": 25367.62, "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": "621212286" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 407.07, "providers": [{ "billed_charge": 1200.00, "npi": [1962587832] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13272.00, "providers": [{ "billed_charge": 73870.29, "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": 1481.88, "providers": [{ "billed_charge": 9460.00, "npi": [1234567893] } ] } ] } ] }, { "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": 868.80, "providers": [{ "billed_charge": 2240.00, "npi": [1234567893] } ] }, { "allowed_amount": 217.20, "providers": [{ "billed_charge": 560.00, "npi": [1234567893] } ] } ] } ] }, { "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": "832297809" }, "service_code": ["57"], "billing_class": "professional", "payments": [{ "allowed_amount": 6856.83, "providers": [{ "billed_charge": 28200.00, "npi": [1760111934] } ] } ] }, { "tin": { "type": "ein", "value": "832141420" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 617.94, "providers": [{ "billed_charge": 1980.00, "npi": [1598826349] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 214.56, "providers": [{ "billed_charge": 907.20, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2297.97, "providers": [{ "billed_charge": 17532.92, "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": "274135289" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 1991.92, "providers": [{ "billed_charge": 4979.76, "npi": [1497135503] } ] } ] } ] }, { "name": "OFF-BASED TX ODU;AL 70 M 1ST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2086", "description": "OFF-BASED TX OPIOID USE D/O; AL 70 MIN 1ST CA MO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "464126690" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6080.20, "providers": [{ "billed_charge": 8550.00, "npi": [1811994700] } ] }, { "allowed_amount": 8406.67, "providers": [{ "billed_charge": 12200.00, "npi": [1811932700] } ] } ] } ] }, { "name": "OFF-BSD TX OUD;AL 60 M SUBSE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2087", "description": "OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880931488" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16366.70, "providers": [{ "billed_charge": 23500.00, "npi": [1912312976] } ] } ] }, { "tin": { "type": "ein", "value": "834383631" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 29684.76, "providers": [{ "billed_charge": 40599.06, "npi": [1467995613] } ] } ] }, { "tin": { "type": "ein", "value": "832141420" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7380.71, "providers": [{ "billed_charge": 13800.00, "npi": [1598826349] } ] } ] }, { "tin": { "type": "ein", "value": "464126690" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3032.84, "providers": [{ "billed_charge": 3306.70, "npi": [1487638102] } ] }, { "allowed_amount": 9839.44, "providers": [{ "billed_charge": 10849.26, "npi": [1811932700] } ] }, { "allowed_amount": 3422.72, "providers": [{ "billed_charge": 3600.00, "npi": [1811994700] } ] } ] } ] }, { "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": "832141420" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 202.14, "providers": [{ "billed_charge": 630.00, "npi": [1598826349] } ] } ] }, { "tin": { "type": "ein", "value": "473488727" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 173.84, "providers": [{ "billed_charge": 650.00, "npi": [1225648009] } ] }, { "allowed_amount": 96.41, "providers": [{ "billed_charge": 400.00, "npi": [1225648009] } ] } ] } ] }, { "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": "992174368" }, "service_code": ["57"], "billing_class": "professional", "payments": [{ "allowed_amount": 17400.00, "providers": [{ "billed_charge": 217500.00, "npi": [1083976971] } ] } ] } ] }, { "name": "LOCM 300-399 MG/ML I CONC PE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "Q9967", "description": "LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843073102" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.00, "providers": [{ "billed_charge": 500.00, "npi": [1861913790] } ] } ] } ] }, { "name": "GLBAL FEE URGNT CARE CENTERS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9083", "description": "GLOBAL FEE URGENT CARE CENTERS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "383878115" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 33135.00, "providers": [{ "billed_charge": 70375.00, "npi": [1477087658] } ] } ] }, { "tin": { "type": "ein", "value": "205277615" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.00, "providers": [{ "billed_charge": 221.00, "npi": [1245250414] } ] }, { "allowed_amount": 1351.00, "providers": [{ "billed_charge": 1547.00, "npi": [1023427481] } ] }, { "allowed_amount": 579.00, "providers": [{ "billed_charge": 663.00, "npi": [1295328342] } ] }, { "allowed_amount": 1158.00, "providers": [{ "billed_charge": 1326.00, "npi": [1467950105] } ] } ] } ] } ] }