{ "reporting_entity_name": "AMPS", "reporting_entity_type": "third party", "last_updated_on": "2026-06-26", "version": "v2.1.0", "out_of_network": [ { "name": "Ct thorax w/o dye", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "71250", "description": "Ct thorax w/o dye", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251352685" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 205.76, "providers": [ { "billed_charge": 4995, "npi": [ 1851370910 ] } ] } ] } ] }, { "name": "X-ray exam l-2 spine 4/>vws", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "72110", "description": "X-ray exam l-2 spine 4/>vws", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231352174" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 1006, "providers": [ { "billed_charge": 1006, "npi": [ 1225091697 ] } ] } ] } ] }, { "name": "X-ray exam si joints", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "72200", "description": "X-ray exam si joints", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231352174" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 472, "providers": [ { "billed_charge": 472, "npi": [ 1225091697 ] } ] } ] } ] }, { "name": "Ct abd & pelv w/contrast", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "74177", "description": "Ct abd & pelv w/contrast", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 419.78, "providers": [ { "billed_charge": 13160, "npi": [ 1164400131 ] } ] } ] } ] }, { "name": "Transvaginal us non-ob", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "76830", "description": "Transvaginal us non-ob", "allowed_amounts": [ { "tin": { "type": "ein", "value": "042103590" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 204.53, "providers": [ { "billed_charge": 670, "npi": [ 1407804669 ] } ] } ] } ] }, { "name": "Us exam pelvic complete", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "76856", "description": "Us exam pelvic complete", "allowed_amounts": [ { "tin": { "type": "ein", "value": "042103590" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 182.54, "providers": [ { "billed_charge": 773, "npi": [ 1407804669 ] } ] } ] } ] }, { "name": "Breast tomosynthesis bi", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "77063", "description": "Breast tomosynthesis bi", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251352685" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 36.78, "providers": [ { "billed_charge": 867, "npi": [ 1851370910 ] } ] } ] } ] }, { "name": "Scr mammo bi incl cad", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "77067", "description": "Scr mammo bi incl cad", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251352685" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 141.58, "providers": [ { "billed_charge": 2388, "npi": [ 1851370910 ] } ] } ] } ] }, { "name": "Pet image w/ct skull-thigh", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "78815", "description": "Pet image w/ct skull-thigh", "allowed_amounts": [ { "tin": { "type": "ein", "value": "222774717" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 8260, "providers": [ { "billed_charge": 8260, "npi": [ 1689714255 ] } ] } ] } ] }, { "name": "Metabolic panel total ca", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "80048", "description": "Metabolic panel total ca", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251801532" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 12.69, "providers": [ { "billed_charge": 52, "npi": [ 1063422053 ] } ] } ] } ] }, { "name": "General health panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "80050", "description": "General health panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35, "providers": [ { "billed_charge": 317.18, "npi": [ 1194062448 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Electrolyte panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "80051", "description": "Electrolyte panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 7.01, "providers": [ { "billed_charge": 24.69, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Comprehen metabolic panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "80053", "description": "Comprehen metabolic panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 15.84, "providers": [ { "billed_charge": 340, "npi": [ 1164400131 ] }, { "billed_charge": 361, "npi": [ 1073587119 ] } ] }, { "allowed_amount": 10.56, "providers": [ { "billed_charge": 48.3, "npi": [ 1063497451 ] }, { "billed_charge": 105.79, "npi": [ 1619040284 ] } ] } ] } ] }, { "name": "Lipid panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "80061", "description": "Lipid panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251010303" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 20.09, "providers": [ { "billed_charge": 160, "npi": [ 1073587119 ] } ] }, { "allowed_amount": 13.39, "providers": [ { "billed_charge": 177.9, "npi": [ 1194062448 ] }, { "billed_charge": 102.9, "npi": [ 1063497451 ] } ] } ] } ] }, { "name": "Hepatic function panel", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "80076", "description": "Hepatic function panel", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 8.17, "providers": [ { "billed_charge": 43.05, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Urinalysis auto w/scope", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "81001", "description": "Urinalysis auto w/scope", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 4.76, "providers": [ { "billed_charge": 110, "npi": [ 1164400131 ] } ] } ] } ] }, { "name": "Oncology colorectal scr", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "81528", "description": "Oncology colorectal scr", "allowed_amounts": [ { "tin": { "type": "ein", "value": "463095174" }, "billing_class": "professional", "payments": [ { "allowed_amount": 508.87, "providers": [ { "billed_charge": 681, "npi": [ 1629407069 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of serum albumin", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "82040", "description": "Assay of serum albumin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 4.95, "providers": [ { "billed_charge": 38.85, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Vitamin d 25 hydroxy", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "82306", "description": "Vitamin d 25 hydroxy", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 29.6, "providers": [ { "billed_charge": 290.49, "npi": [ 1194062448 ] }, { "billed_charge": 286.65, "npi": [ 1063497451 ] }, { "billed_charge": 113.5, "npi": [ 1295726032 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of creatinine", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "82565", "description": "Assay of creatinine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.12, "providers": [ { "billed_charge": 6.17, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of estradiol", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "82670", "description": "Assay of estradiol", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 27.94, "providers": [ { "billed_charge": 268.89, "npi": [ 1194062448 ] }, { "billed_charge": 182.7, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay glucose blood quant", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "82947", "description": "Assay glucose blood quant", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 5.9, "providers": [ { "billed_charge": 110, "npi": [ 1164400131 ] } ], "billing_code_modifier": [ "QW" ] }, { "allowed_amount": 3.93, "providers": [ { "billed_charge": 6.17, "npi": [ 1063497451 ] } ] } ] } ] }, { "name": "Assay of gonadotropin (fsh)", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "83001", "description": "Assay of gonadotropin (fsh)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 18.58, "providers": [ { "billed_charge": 162.14, "npi": [ 1194062448 ] }, { "billed_charge": 112.35, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of gonadotropin (lh)", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "83002", "description": "Assay of gonadotropin (lh)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 18.52, "providers": [ { "billed_charge": 162.14, "npi": [ 1194062448 ] }, { "billed_charge": 109.2, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Glycosylated hemoglobin test", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "83036", "description": "Glycosylated hemoglobin test", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.71, "providers": [ { "billed_charge": 69.3, "npi": [ 1063497451 ] }, { "billed_charge": 89.2, "npi": [ 1619040284 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of lipase", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "83690", "description": "Assay of lipase", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 10.34, "providers": [ { "billed_charge": 155, "npi": [ 1164400131 ] } ] } ] } ] }, { "name": "Assay of prolactin", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "84146", "description": "Assay of prolactin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 19.38, "providers": [ { "billed_charge": 139.65, "npi": [ 1063497451 ] }, { "billed_charge": 139.65, "npi": [ 1295726032 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of sex hormone globul", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "84270", "description": "Assay of sex hormone globul", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 21.73, "providers": [ { "billed_charge": 148.05, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of free testosterone", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "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": 208.95, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of total testosterone", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "84403", "description": "Assay of total testosterone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 25.81, "providers": [ { "billed_charge": 162.75, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of free thyroxine", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "84439", "description": "Assay of free thyroxine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 9.02, "providers": [ { "billed_charge": 122.85, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay thyroid stim hormone", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "84443", "description": "Assay thyroid stim hormone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 16.8, "providers": [ { "billed_charge": 109.2, "npi": [ 1063497451 ] }, { "billed_charge": 98.7, "npi": [ 1295726032 ] }, { "billed_charge": 156.74, "npi": [ 1619040284 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay triiodothyronine (t3)", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "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": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Assay of urea nitrogen", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "84520", "description": "Assay of urea nitrogen", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 3.95, "providers": [ { "billed_charge": 6.18, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Chorionic gonadotropin test", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "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": [ 1295726032 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Complete cbc w/auto diff wbc", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "85025", "description": "Complete cbc w/auto diff wbc", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 11.66, "providers": [ { "billed_charge": 245, "npi": [ 1164400131 ] } ] }, { "allowed_amount": 7.77, "providers": [ { "billed_charge": 26.6, "npi": [ 1295726032 ] } ] } ] } ] }, { "name": "Complete cbc automated", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "85027", "description": "Complete cbc automated", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251801532" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 9.71, "providers": [ { "billed_charge": 36, "npi": [ 1063422053 ] } ] }, { "allowed_amount": 6.47, "providers": [ { "billed_charge": 32.23, "npi": [ 1063497451 ] } ] } ] } ] }, { "name": "Rbc sed rate automated", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "85652", "description": "Rbc sed rate automated", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 2.7, "providers": [ { "billed_charge": 37.8, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "C-reactive protein", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "86140", "description": "C-reactive protein", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 5.18, "providers": [ { "billed_charge": 84, "npi": [ 1063497451 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Hpv high-risk types", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "87624", "description": "Hpv high-risk types", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 35.09, "providers": [ { "billed_charge": 157.21, "npi": [ 1194062448 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Cytopath c/v auto fluid redo", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "88175", "description": "Cytopath c/v auto fluid redo", "allowed_amounts": [ { "tin": { "type": "ein", "value": "043248020" }, "billing_class": "professional", "payments": [ { "allowed_amount": 26.61, "providers": [ { "billed_charge": 131.73, "npi": [ 1194062448 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Tissue exam by pathologist", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "88305", "description": "Tissue exam by pathologist", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "billing_class": "professional", "payments": [ { "allowed_amount": 133.76, "providers": [ { "billed_charge": 373.8, "npi": [ 1417245176 ] } ] } ], "service_code": [ "81" ] } ] }, { "name": "Immunization admin", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "90471", "description": "Immunization admin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "271348772" }, "billing_class": "professional", "payments": [ { "allowed_amount": 29.46, "providers": [ { "billed_charge": 79, "npi": [ 1649226515 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Iiv3 vacc no prsv 0.5 ml im", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "90656", "description": "Iiv3 vacc no prsv 0.5 ml im", "allowed_amounts": [ { "tin": { "type": "ein", "value": "271348772" }, "billing_class": "professional", "payments": [ { "allowed_amount": 23.47, "providers": [ { "billed_charge": 177, "npi": [ 1649226515 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Electrocardiogram tracing", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "93005", "description": "Electrocardiogram tracing", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251801532" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 9.68, "providers": [ { "billed_charge": 146, "npi": [ 1063422053 ] } ] } ] } ] }, { "name": "Cardiac rehab", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "93797", "description": "Cardiac rehab", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251010303" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 11.33, "providers": [ { "billed_charge": 420, "npi": [ 1073587119 ] } ] } ] } ] }, { "name": "Cardiac rehab/monitor", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "93798", "description": "Cardiac rehab/monitor", "allowed_amounts": [ { "tin": { "type": "ein", "value": "251010303" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 17.73, "providers": [ { "billed_charge": 420, "npi": [ 1073587119 ] } ] } ] } ] }, { "name": "Office/outpatient visit est", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "99214", "description": "Office/outpatient visit est", "allowed_amounts": [ { "tin": { "type": "ein", "value": "271348772" }, "billing_class": "professional", "payments": [ { "allowed_amount": 167.88, "providers": [ { "billed_charge": 363, "npi": [ 1649226515 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Emergency dept visit", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "99285", "description": "Emergency dept visit", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 248.91, "providers": [ { "billed_charge": 4030, "npi": [ 1164400131 ] } ] } ] } ] }, { "name": "Prev visit est age 18-39", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "99395", "description": "Prev visit est age 18-39", "allowed_amounts": [ { "tin": { "type": "ein", "value": "271348772" }, "billing_class": "professional", "payments": [ { "allowed_amount": 152.7, "providers": [ { "billed_charge": 233, "npi": [ 1649226515 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "Tubing with heating element", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "A4604", "description": "Tubing with heating element", "allowed_amounts": [ { "tin": { "type": "ein", "value": "020014798" }, "billing_class": "professional", "payments": [ { "allowed_amount": 49.98, "providers": [ { "billed_charge": 74.06, "npi": [ 1134303902 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "CPAP full face mask", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "A7030", "description": "CPAP full face mask", "allowed_amounts": [ { "tin": { "type": "ein", "value": "020014798" }, "billing_class": "professional", "payments": [ { "allowed_amount": 111.88, "providers": [ { "billed_charge": 242.06, "npi": [ 1134303902 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "Replacement facemask interfa", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "A7031", "description": "Replacement facemask interfa", "allowed_amounts": [ { "tin": { "type": "ein", "value": "020014798" }, "billing_class": "professional", "payments": [ { "allowed_amount": 125.88, "providers": [ { "billed_charge": 273.75, "npi": [ 1134303902 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "Pos airway pressure filter", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "A7038", "description": "Pos airway pressure filter", "allowed_amounts": [ { "tin": { "type": "ein", "value": "020014798" }, "billing_class": "professional", "payments": [ { "allowed_amount": 15.84, "providers": [ { "billed_charge": 41.89, "npi": [ 1134303902 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "F18 fdg", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "A9552", "description": "F18 fdg", "allowed_amounts": [ { "tin": { "type": "ein", "value": "222774717" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 457, "providers": [ { "billed_charge": 457, "npi": [ 1689714255 ] } ] } ] } ] }, { "name": "Ketorolac tromethamine inj", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "J1885", "description": "Ketorolac tromethamine inj", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 0.5, "providers": [ { "billed_charge": 87.13, "npi": [ 1164400131 ] } ] } ] } ] }, { "name": "Ondansetron hcl injection", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "J2405", "description": "Ondansetron hcl injection", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 0.54, "providers": [ { "billed_charge": 86.79, "npi": [ 1164400131 ] } ] } ] } ] }, { "name": "Fentanyl citrate injection", "billing_code_type": "CPT", "billing_code_type_version": "2026-06-26", "billing_code": "J3010", "description": "Fentanyl citrate injection", "allowed_amounts": [ { "tin": { "type": "ein", "value": "231689692" }, "billing_class": "institutional", "payments": [ { "allowed_amount": 3.57, "providers": [ { "billed_charge": 218.36, "npi": [ 1164400131 ] } ] } ] } ] } ] }