{ "reporting_entity_name": "AMPS", "reporting_entity_type": "third party", "last_updated_on": "2026-05-26", "version": "v2.1.0", "out_of_network": [ { "name": "Remove foreign body", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "10121", "description": "Remove foreign body", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 337.95, "providers": [ { "billed_charge": 400, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Implant hormone pellet(s)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "11980", "description": "Implant hormone pellet(s)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 127.37, "providers": [ { "billed_charge": 150, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Drain/inj joint/bursa w/o us", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "20610", "description": "Drain/inj joint/bursa w/o us", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 83.3, "providers": [ { "billed_charge": 194, "npi": [ 1497704217 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Total knee arthroplasty", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "27447", "description": "Total knee arthroplasty", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 936.65, "providers": [ { "billed_charge": 3275, "npi": [ 1497704217 ] } ] } ], "service_code": [ "24" ] } ] }, { "name": "Circumcision w/regionl block", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "54150", "description": "Circumcision w/regionl block", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 201.01, "providers": [ { "billed_charge": 260, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam chest 1 view", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "71045", "description": "X-ray exam chest 1 view", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 31.9, "providers": [ { "billed_charge": 90, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam chest 2 views", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "71046", "description": "X-ray exam chest 2 views", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 42.01, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam thorac spine 2vws", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "72070", "description": "X-ray exam thorac spine 2vws", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 40.45, "providers": [ { "billed_charge": 120, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam l-s spine 2/3 vws", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "72100", "description": "X-ray exam l-s spine 2/3 vws", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 51.27, "providers": [ { "billed_charge": 120, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam sacrum tailbone", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "72220", "description": "X-ray exam sacrum tailbone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 40.64, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam of elbow", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73080", "description": "X-ray exam of elbow", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 41.9, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam of wrist", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73110", "description": "X-ray exam of wrist", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 50.46, "providers": [ { "billed_charge": 95, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam of hand", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73130", "description": "X-ray exam of hand", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 45.62, "providers": [ { "billed_charge": 110, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam of finger(s)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73140", "description": "X-ray exam of finger(s)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 46.7, "providers": [ { "billed_charge": 75, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam knee 4 or more", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73564", "description": "X-ray exam knee 4 or more", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 57.9, "providers": [ { "billed_charge": 102, "npi": [ 1497704217 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam of lower leg", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73590", "description": "X-ray exam of lower leg", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 38.7, "providers": [ { "billed_charge": 82, "npi": [ 1497704217 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "X-ray exam of toe(s)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "73660", "description": "X-ray exam of toe(s)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 36.3, "providers": [ { "billed_charge": 75, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Us exam of head and neck", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "76536", "description": "Us exam of head and neck", "allowed_amounts": [ { "tin": { "type": "ein", "value": "862109896" }, "billing_class": "professional", "payments": [ { "allowed_amount": 33.82, "providers": [ { "billed_charge": 105, "npi": [ 1205553369 ] } ], "billing_code_modifier": [ "26" ] } ], "service_code": [ "22" ] } ] }, { "name": "Breast tomosynthesis bi", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "77063", "description": "Breast tomosynthesis bi", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 65.08, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Scr mammo bi incl cad", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "77067", "description": "Scr mammo bi incl cad", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 157.57, "providers": [ { "billed_charge": 230, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Metabolic panel total ca", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "80048", "description": "Metabolic panel total ca", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.46, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] }, { "billed_charge": 25, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "General health panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "80050", "description": "General health panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35, "providers": [ { "billed_charge": 71, "npi": [ 1225085707 ] }, { "billed_charge": 302.08, "npi": [ 1932166386 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Comprehen metabolic panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "80053", "description": "Comprehen metabolic panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] }, { "billed_charge": 48.3, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Lipid panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "80061", "description": "Lipid panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 13.39, "providers": [ { "billed_charge": 40, "npi": [ 1225085707 ] }, { "billed_charge": 40, "npi": [ 1225085707 ] }, { "billed_charge": 102.9, "npi": [ 1538144910 ] }, { "billed_charge": 169.43, "npi": [ 1932166386 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Hepatic function panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "80076", "description": "Hepatic function panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.17, "providers": [ { "billed_charge": 30, "npi": [ 1225085707 ] }, { "billed_charge": 30, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Obstetric panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "80081", "description": "Obstetric panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 74.86, "providers": [ { "billed_charge": 239.39, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Urinalysis auto w/scope", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "81001", "description": "Urinalysis auto w/scope", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 3.17, "providers": [ { "billed_charge": 10, "npi": [ 1225085707 ] }, { "billed_charge": 10, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Urinalysis auto w/o scope", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "81003", "description": "Urinalysis auto w/o scope", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 2.25, "providers": [ { "billed_charge": 10, "npi": [ 1225085707 ] }, { "billed_charge": 10, "npi": [ 1225085707 ] } ], "billing_code_modifier": [ "QW" ] } ], "service_code": [ "11" ] } ] }, { "name": "Urine pregnancy test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "81025", "description": "Urine pregnancy test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.61, "providers": [ { "billed_charge": 35, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Ur albumin quantitative", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82043", "description": "Ur albumin quantitative", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.78, "providers": [ { "billed_charge": 10, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Bilirubin total", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82247", "description": "Bilirubin total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.02, "providers": [ { "billed_charge": 20, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Bilirubin direct", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82248", "description": "Bilirubin direct", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.02, "providers": [ { "billed_charge": 20, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Vitamin d 25 hydroxy", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82306", "description": "Vitamin d 25 hydroxy", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 29.6, "providers": [ { "billed_charge": 80, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay three catecholamines", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82384", "description": "Assay three catecholamines", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 25.25, "providers": [ { "billed_charge": 228.9, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of urine creatinine", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82570", "description": "Assay of urine creatinine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.18, "providers": [ { "billed_charge": 15, "npi": [ 1225085707 ] }, { "billed_charge": 54.71, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Vitamin b-12", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82607", "description": "Vitamin b-12", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 15.08, "providers": [ { "billed_charge": 65, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Dehydroepiandrosterone", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82626", "description": "Dehydroepiandrosterone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 25.27, "providers": [ { "billed_charge": 229.95, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of estradiol", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82670", "description": "Assay of estradiol", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 27.94, "providers": [ { "billed_charge": 182.7, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of ferritin", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82728", "description": "Assay of ferritin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 13.63, "providers": [ { "billed_charge": 80, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of folic acid serum", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82746", "description": "Assay of folic acid serum", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 14.7, "providers": [ { "billed_charge": 60, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay iga/igd/igg/igm each", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82784", "description": "Assay iga/igd/igg/igm each", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.3, "providers": [ { "billed_charge": 92.69, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay glucose blood quant", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82947", "description": "Assay glucose blood quant", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 3.93, "providers": [ { "billed_charge": 38.85, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Glucose test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "82950", "description": "Glucose test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4.75, "providers": [ { "billed_charge": 17, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hemoglobin electrophoresis", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83020", "description": "Hemoglobin electrophoresis", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 45, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Glycosylated hemoglobin test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83036", "description": "Glycosylated hemoglobin test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.71, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] }, { "billed_charge": 25, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of iron", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83540", "description": "Assay of iron", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.47, "providers": [ { "billed_charge": 36, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Iron binding test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83550", "description": "Iron binding test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.74, "providers": [ { "billed_charge": 40, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of lead", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83655", "description": "Assay of lead", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 12.11, "providers": [ { "billed_charge": 77.7, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of lipoprotein(a)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83695", "description": "Assay of lipoprotein(a)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 14.32, "providers": [ { "billed_charge": 126, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of magnesium", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83735", "description": "Assay of magnesium", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.7, "providers": [ { "billed_charge": 45, "npi": [ 1225085707 ] }, { "billed_charge": 45, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of metanephrines", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "83835", "description": "Assay of metanephrines", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 16.94, "providers": [ { "billed_charge": 296.1, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of psa total", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84153", "description": "Assay of psa total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 18.39, "providers": [ { "billed_charge": 50, "npi": [ 1225085707 ] }, { "billed_charge": 50, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of protein urine", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84156", "description": "Assay of protein urine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 3.67, "providers": [ { "billed_charge": 38.74, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of somatomedin", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84305", "description": "Assay of somatomedin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 21.26, "providers": [ { "billed_charge": 247.8, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of free testosterone", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84402", "description": "Assay of free testosterone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 25.47, "providers": [ { "billed_charge": 183.3175, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of total testosterone", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84403", "description": "Assay of total testosterone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 25.81, "providers": [ { "billed_charge": 75, "npi": [ 1225085707 ] }, { "billed_charge": 75, "npi": [ 1225085707 ] }, { "billed_charge": 185.7575, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of total thyroxine", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84436", "description": "Assay of total thyroxine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.87, "providers": [ { "billed_charge": 43.57, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of free thyroxine", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84439", "description": "Assay of free thyroxine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.442857142857143, "providers": [ { "billed_charge": 61, "npi": [ 1225085707 ] } ] }, { "allowed_amount": 9.02, "providers": [ { "billed_charge": 71.55, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay thyroid stim hormone", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84443", "description": "Assay thyroid stim hormone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 16.8, "providers": [ { "billed_charge": 45, "npi": [ 1225085707 ] }, { "billed_charge": 45, "npi": [ 1225085707 ] }, { "billed_charge": 117.9, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of thyroid (t3 or t4)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84479", "description": "Assay of thyroid (t3 or t4)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.47, "providers": [ { "billed_charge": 41.03, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay triiodothyronine (t3)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84480", "description": "Assay triiodothyronine (t3)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 14.18, "providers": [ { "billed_charge": 118.65, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Free assay (ft-3)", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84481", "description": "Free assay (ft-3)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 16.94, "providers": [ { "billed_charge": 198.45, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of blood/uric acid", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84550", "description": "Assay of blood/uric acid", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4.52, "providers": [ { "billed_charge": 20, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Assay of zinc", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84630", "description": "Assay of zinc", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 11.39, "providers": [ { "billed_charge": 95.55, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Chorionic gonadotropin test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "84702", "description": "Chorionic gonadotropin test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 15.05, "providers": [ { "billed_charge": 126, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Complete cbc w/auto diff wbc", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "85025", "description": "Complete cbc w/auto diff wbc", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 7.77, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] }, { "billed_charge": 25, "npi": [ 1225085707 ] } ] }, { "allowed_amount": 3.885, "providers": [ { "billed_charge": 9.5, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Complete cbc automated", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "85027", "description": "Complete cbc automated", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.47, "providers": [ { "billed_charge": 32.23, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Russell viper venom diluted", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "85613", "description": "Russell viper venom diluted", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.58, "providers": [ { "billed_charge": 146.04, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Rbc sed rate nonautomated", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "85651", "description": "Rbc sed rate nonautomated", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4.27, "providers": [ { "billed_charge": 15, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Thromboplastin time partial", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "85730", "description": "Thromboplastin time partial", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.01, "providers": [ { "billed_charge": 46.2, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Thromboplastin time partial", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "85732", "description": "Thromboplastin time partial", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.47, "providers": [ { "billed_charge": 98.61, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "C-reactive protein", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86140", "description": "C-reactive protein", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.18, "providers": [ { "billed_charge": 33, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Beta-2 glycoprotein antibody", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86146", "description": "Beta-2 glycoprotein antibody", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 50.9, "providers": [ { "billed_charge": 214.2, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Cardiolipin antibody ea ig", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86147", "description": "Cardiolipin antibody ea ig", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 50.9, "providers": [ { "billed_charge": 229.95, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Microsomal antibody each", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86376", "description": "Microsomal antibody each", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 14.55, "providers": [ { "billed_charge": 93.29, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Tb test cell immun measure", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86480", "description": "Tb test cell immun measure", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 61.98, "providers": [ { "billed_charge": 238.35, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Tb intradermal test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86580", "description": "Tb intradermal test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.9, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Syphilis test non-trep qual", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86592", "description": "Syphilis test non-trep qual", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 2.8466666666666667, "providers": [ { "billed_charge": 18.316666666666666, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hep b core antibody total", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86704", "description": "Hep b core antibody total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 12.05, "providers": [ { "billed_charge": 96.3, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hep b surface antibody", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86706", "description": "Hep b surface antibody", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 10.74, "providers": [ { "billed_charge": 85.9, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hepatitis a antibody", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86708", "description": "Hepatitis a antibody", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 12.39, "providers": [ { "billed_charge": 99.02, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Thyroglobulin antibody", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86800", "description": "Thyroglobulin antibody", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 15.91, "providers": [ { "billed_charge": 102.01, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hepatitis c ab test", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "86803", "description": "Hepatitis c ab test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 14.27, "providers": [ { "billed_charge": 79.32, "npi": [ 1538144910 ] }, { "billed_charge": 166, "npi": [ 1932166386 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Culture othr specimn aerobic", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87070", "description": "Culture othr specimn aerobic", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.62, "providers": [ { "billed_charge": 108.42, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Cultr bacteria except blood", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87075", "description": "Cultr bacteria except blood", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.47, "providers": [ { "billed_charge": 131.37, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Culture screen only", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87081", "description": "Culture screen only", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 6.63, "providers": [ { "billed_charge": 30.88, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Urine culture/colony count", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87086", "description": "Urine culture/colony count", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.07, "providers": [ { "billed_charge": 75.6, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Skin fungi culture", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87101", "description": "Skin fungi culture", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 7.71, "providers": [ { "billed_charge": 85.83, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Fungi identification yeast", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87106", "description": "Fungi identification yeast", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 10.32, "providers": [ { "billed_charge": 59.05, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Dna/rna amplified probe", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87150", "description": "Dna/rna amplified probe", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35.09, "providers": [ { "billed_charge": 163.37, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Ova and parasites smears", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87177", "description": "Ova and parasites smears", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.9, "providers": [ { "billed_charge": 32.32, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Microbe susceptible mic", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87186", "description": "Microbe susceptible mic", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.65, "providers": [ { "billed_charge": 88.2, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Smear fluorescent/acid stai", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87206", "description": "Smear fluorescent/acid stai", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.39, "providers": [ { "billed_charge": 59.995, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Smear complex stain", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87209", "description": "Smear complex stain", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 17.98, "providers": [ { "billed_charge": 65.33, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Tissue exam for fungi", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87220", "description": "Tissue exam for fungi", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4.27, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Hepatitis b surface ag ia", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87340", "description": "Hepatitis b surface ag ia", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.165, "providers": [ { "billed_charge": 41.25, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hiv-1 ag w/hiv-1 & hiv-2 ab", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87389", "description": "Hiv-1 ag w/hiv-1 & hiv-2 ab", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 16.053333333333335, "providers": [ { "billed_charge": 86.8, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Chylmd trach dna amp probe", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87491", "description": "Chylmd trach dna amp probe", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35.09, "providers": [ { "billed_charge": 124.225, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "N.gonorrhoeae dna amp prob", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87591", "description": "N.gonorrhoeae dna amp prob", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35.09, "providers": [ { "billed_charge": 124.225, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hpv high-risk types", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87624", "description": "Hpv high-risk types", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35.09, "providers": [ { "billed_charge": 177.94, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Trichomonas vaginalis amplif", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87661", "description": "Trichomonas vaginalis amplif", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35.09, "providers": [ { "billed_charge": 119.29, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Detect agent nos dna amp", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87798", "description": "Detect agent nos dna amp", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 52.635, "providers": [ { "billed_charge": 178.95, "npi": [ 1538144910 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Detect agnt mult dna ampli", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87801", "description": "Detect agnt mult dna ampli", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 70.2, "providers": [ { "billed_charge": 115, "npi": [ 1225085707 ] }, { "billed_charge": 238.66, "npi": [ 1538144910 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Strep a assay w/optic", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "87880", "description": "Strep a assay w/optic", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 16.53, "providers": [ { "billed_charge": 50, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Cytopath c/v auto fluid redo", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "88175", "description": "Cytopath c/v auto fluid redo", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 26.61, "providers": [ { "billed_charge": 134.96, "npi": [ 1538144910 ] }, { "billed_charge": 228.25, "npi": [ 1811005150 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Immunization admin", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90471", "description": "Immunization admin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 25.848684210526315, "providers": [ { "billed_charge": 40, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Hepa vacc ped/adol 2 dose im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90633", "description": "Hepa vacc ped/adol 2 dose im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 41.45, "providers": [ { "billed_charge": 125, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "9vhpv vaccine 2/3 dose im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90651", "description": "9vhpv vaccine 2/3 dose im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 345.54, "providers": [ { "billed_charge": 385, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Iiv3 vacc no prsv 0.5 ml im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90656", "description": "Iiv3 vacc no prsv 0.5 ml im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 23.47, "providers": [ { "billed_charge": 35, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Cciiv3 vac no prsv 0.5 ml im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90661", "description": "Cciiv3 vac no prsv 0.5 ml im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 39.41967741935484, "providers": [ { "billed_charge": 43.225806451612904, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Rv5 vacc 3 dose live oral", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90680", "description": "Rv5 vacc 3 dose live oral", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 103.76, "providers": [ { "billed_charge": 125, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Dtap-ipv/hib vaccine im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90698", "description": "Dtap-ipv/hib vaccine im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 126.06, "providers": [ { "billed_charge": 138, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Dtap vaccine < 7 yrs im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90700", "description": "Dtap vaccine < 7 yrs im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 31.91, "providers": [ { "billed_charge": 40, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Mmrv vaccine sc", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90710", "description": "Mmrv vaccine sc", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 292.07, "providers": [ { "billed_charge": 340, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Poliovirus ipv sc/im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90713", "description": "Poliovirus ipv sc/im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 50.2, "providers": [ { "billed_charge": 52, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Td vacc no presv 7 yrs+ im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90714", "description": "Td vacc no presv 7 yrs+ im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 40.92, "providers": [ { "billed_charge": 80, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Tdap vaccine 7 yrs/> im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90715", "description": "Tdap vaccine 7 yrs/> im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 41.69, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Var vaccine live subq", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90716", "description": "Var vaccine live subq", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 196.94, "providers": [ { "billed_charge": 220, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Mcv4 menacwy vaccine im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90734", "description": "Mcv4 menacwy vaccine im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 175, "providers": [ { "billed_charge": 175, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Hepb vacc 3 dose ped/adol im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90744", "description": "Hepb vacc 3 dose ped/adol im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 34.86, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Hzv vacc recombinant im", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "90750", "description": "Hzv vacc recombinant im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 226.29, "providers": [ { "billed_charge": 250, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Pure tone hearing test air", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "92551", "description": "Pure tone hearing test air", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 15.97, "providers": [ { "billed_charge": 20, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Electrocardiogram complete", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "93000", "description": "Electrocardiogram complete", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 18.37, "providers": [ { "billed_charge": 85, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Developmental screen w/score", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "96110", "description": "Developmental screen w/score", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 13.258, "providers": [ { "billed_charge": 20, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Osteopath manj 1-2 regions", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "98925", "description": "Osteopath manj 1-2 regions", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 36.25, "providers": [ { "billed_charge": 70, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Osteopath manj 3-4 regions", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "98926", "description": "Osteopath manj 3-4 regions", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 53.223076923076924, "providers": [ { "billed_charge": 90, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Osteopath manj 5-6 regions", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "98927", "description": "Osteopath manj 5-6 regions", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 69.655, "providers": [ { "billed_charge": 100, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Osteopath manj 7-8 regions", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "98928", "description": "Osteopath manj 7-8 regions", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 84.75818181818182, "providers": [ { "billed_charge": 115, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Visual acuity screen", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99173", "description": "Visual acuity screen", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 3.033333333333333, "providers": [ { "billed_charge": 25, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Office/outpatient visit new", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99204", "description": "Office/outpatient visit new", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 194.33, "providers": [ { "billed_charge": 390, "npi": [ 1497704217 ] }, { "billed_charge": 280, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Office/outpatient visit est", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99211", "description": "Office/outpatient visit est", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 27.363333333333333, "providers": [ { "billed_charge": 45, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Office/outpatient visit est", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99212", "description": "Office/outpatient visit est", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 66.73857142857143, "providers": [ { "billed_charge": 95, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Office/outpatient visit est", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99213", "description": "Office/outpatient visit est", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 105.8, "providers": [ { "billed_charge": 151, "npi": [ 1497704217 ] } ] }, { "allowed_amount": 106.59615384615384, "providers": [ { "billed_charge": 153, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Office/outpatient visit est", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99214", "description": "Office/outpatient visit est", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 146.81678571428571, "providers": [ { "billed_charge": 214, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Office/outpatient visit est", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99215", "description": "Office/outpatient visit est", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 219.545, "providers": [ { "billed_charge": 300, "npi": [ 1225085707 ] } ] }, { "allowed_amount": 209.46, "providers": [ { "billed_charge": 444, "npi": [ 1205553369 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Per pm reeval est pat infant", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99391", "description": "Per pm reeval est pat infant", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 117.94, "providers": [ { "billed_charge": 200, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Prev visit est age 1-4", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99392", "description": "Prev visit est age 1-4", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 108.075, "providers": [ { "billed_charge": 166.25, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Prev visit est age 5-11", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99393", "description": "Prev visit est age 5-11", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 126.82, "providers": [ { "billed_charge": 183.33333333333334, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Prev visit est age 12-17", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99394", "description": "Prev visit est age 12-17", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 95.8775, "providers": [ { "billed_charge": 150, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Prev visit est age 18-39", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99395", "description": "Prev visit est age 18-39", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 139.3525, "providers": [ { "billed_charge": 200, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Prev visit est age 40-64", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "99396", "description": "Prev visit est age 40-64", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 148.284, "providers": [ { "billed_charge": 215, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Tubing with heating element", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "A4604", "description": "Tubing with heating element", "allowed_amounts": [ { "tin": { "type": "ein", "value": "421685996" }, "billing_class": "professional", "payments": [ { "allowed_amount": 67.22, "providers": [ { "billed_charge": 85.32, "npi": [ 1891728697 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "CPAP full face mask", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "A7030", "description": "CPAP full face mask", "allowed_amounts": [ { "tin": { "type": "ein", "value": "421685996" }, "billing_class": "professional", "payments": [ { "allowed_amount": 173.95, "providers": [ { "billed_charge": 199, "npi": [ 1891728697 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "Replacement facemask interfa", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "A7031", "description": "Replacement facemask interfa", "allowed_amounts": [ { "tin": { "type": "ein", "value": "421685996" }, "billing_class": "professional", "payments": [ { "allowed_amount": 60, "providers": [ { "billed_charge": 60, "npi": [ 1891728697 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "Pos airway pressure filter", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "A7038", "description": "Pos airway pressure filter", "allowed_amounts": [ { "tin": { "type": "ein", "value": "421685996" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.24, "providers": [ { "billed_charge": 17.88, "npi": [ 1891728697 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE\tCont airway pressure device\r", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "E0601", "description": "E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE\tCont airway pressure device\r", "allowed_amounts": [ { "tin": { "type": "ein", "value": "421685996" }, "billing_class": "professional", "payments": [ { "allowed_amount": 188, "providers": [ { "billed_charge": 188, "npi": [ 1891728697 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "Annual alcohol screen 15 min", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "G0442", "description": "Annual alcohol screen 15 min", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 19.92888888888889, "providers": [ { "billed_charge": 30, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Ceftriaxone sodium injection", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J0696", "description": "Ceftriaxone sodium injection", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 2.59, "providers": [ { "billed_charge": 48, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Betamethasone acet&sod phosp", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J0702", "description": "Betamethasone acet&sod phosp", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561093722" }, "billing_class": "professional", "payments": [ { "allowed_amount": 37.21, "providers": [ { "billed_charge": 44, "npi": [ 1497704217 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Inj testosterone cypionate", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J1071", "description": "Inj testosterone cypionate", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4.786363636363636, "providers": [ { "billed_charge": 20, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Dexamethasone sodium phos", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J1100", "description": "Dexamethasone sodium phos", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 1.0471428571428572, "providers": [ { "billed_charge": 33.57142857142857, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Ketorolac tromethamine inj", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J1885", "description": "Ketorolac tromethamine inj", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 1.1555555555555557, "providers": [ { "billed_charge": 56.666666666666664, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Ondansetron hcl injection", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J2405", "description": "Ondansetron hcl injection", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.36666666666666664, "providers": [ { "billed_charge": 30, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Triamcinolone acet inj nos", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J3301", "description": "Triamcinolone acet inj nos", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4, "providers": [ { "billed_charge": 36, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Vitamin b12 injection", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "J3420", "description": "Vitamin b12 injection", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 1.112, "providers": [ { "billed_charge": 5, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "L3170", "billing_code_type": "CPT", "billing_code_type_version": "2026-05-26", "billing_code": "L3170", "description": "L3170", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561896953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 30, "providers": [ { "billed_charge": 30, "npi": [ 1225085707 ] } ] } ], "service_code": [ "11" ] } ] } ] }