{ "reporting_entity_name": "Centene Management Company LLC", "reporting_entity_type": "Third Party Administrator", "version": "2.0.0", "last_updated_on": "2026-03-04", "out_of_network": [{ "name": "Under Proprietary Laboratory Analyses", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0340U", "description": "Under Proprietary Laboratory Analyses", "allowed_amounts": [{ "tin": { "type": "ein", "value": "10894487" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32928.06, "providers": [{ "billed_charge": 56900.00, "npi": [1558672279] } ] } ] } ] }, { "name": "RESIDENTIAL TREATMENT-PSYCHI", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1001", "description": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "993480958" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23191.00, "providers": [{ "billed_charge": 242340.00, "npi": [1629895370] } ] } ] } ] }, { "name": "RESIDENTIAL TREATMENT - CHEM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1002", "description": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "873572700" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9800.00, "providers": [{ "billed_charge": 114000.00, "npi": [1245981760] } ] } ] } ] }, { "name": "MED-SUR-GY/PVT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "111", "description": "ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561132" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39501.00, "providers": [{ "billed_charge": 21539.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1448935.22, "providers": [{ "billed_charge": 373185.00, "npi": [1982733655] } ] } ] } ] }, { "name": "PEDS/PVT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "113", "description": "ROOM AND BOARD - PRIVATE -PEDIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 528251.40, "providers": [{ "billed_charge": 818020.00, "npi": [1760480503] } ] } ] } ] }, { "name": "PSTAY/2 BED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "124", "description": "ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "364795061" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 77527.48, "providers": [{ "billed_charge": 99309.92, "npi": [1407480254] } ] }, { "allowed_amount": 29208.80, "providers": [{ "billed_charge": 29208.80, "npi": [1336504380] } ] } ] }, { "tin": { "type": "ein", "value": "331313844" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70932.92, "providers": [{ "billed_charge": 138187.00, "npi": [1841012424] } ] } ] }, { "tin": { "type": "ein", "value": "464207180" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 133756.25, "providers": [{ "billed_charge": 125400.00, "npi": [1740604636] } ] } ] }, { "tin": { "type": "ein", "value": "270355566" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 529185.52, "providers": [{ "billed_charge": 598050.00, "npi": [1083942098] } ] } ] } ] }, { "name": "DETOX/2 BED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "126", "description": "ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "270355566" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 299792.84, "providers": [{ "billed_charge": 336680.00, "npi": [1083942098] } ] } ] }, { "tin": { "type": "ein", "value": "472097678" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39612.59, "providers": [{ "billed_charge": 128737.38, "npi": [1972132231] } ] } ] } ] }, { "name": "DETOX/3&4 BED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "136", "description": "SEMI-PRIVATE - THREE AND FOUR BEDS -DETOXIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870833629" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1282.00, "providers": [{ "billed_charge": 1500.00, "npi": [1245908763] } ] } ] } ] }, { "name": "INTENSIVE CARE OR ICU", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "200", "description": "INTENSIVE CARE - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561134" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 211581.45, "providers": [{ "billed_charge": 51859.00, "npi": [1982733655] } ] } ] } ] }, { "name": "POST ICU", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "206", "description": "INTENSIVE CARE - POST ICU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561132" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 392320.02, "providers": [{ "billed_charge": 376290.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 965683.01, "providers": [{ "billed_charge": 641985.00, "npi": [1982733655] } ] } ] } ] }, { "name": "PHARMACY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "250", "description": "PHARMACY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 594479.57, "providers": [{ "billed_charge": 1085954.00, "npi": [1760480503] } ] }, { "allowed_amount": 18291.70, "providers": [{ "billed_charge": 30477.00, "npi": [1760480503] } ] }, { "allowed_amount": 12120.00, "providers": [{ "billed_charge": 20200.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1396.60, "providers": [{ "billed_charge": 2765.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "860098923" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9.90, "providers": [{ "billed_charge": 33.00, "npi": [1902897820] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 143.01, "providers": [{ "billed_charge": 476.71, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 256.50, "providers": [{ "billed_charge": 209667.04, "npi": [1700910189] } ] }, { "allowed_amount": 265.57, "providers": [{ "billed_charge": 3675.10, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14.77, "providers": [{ "billed_charge": 2340.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.47, "providers": [{ "billed_charge": 167.00, "npi": [1609408665] } ] }, { "allowed_amount": 1.32, "providers": [{ "billed_charge": 37.00, "npi": [1265065445] } ] }, { "allowed_amount": 808.79, "providers": [{ "billed_charge": 9459.00, "npi": [1982733655] } ] }, { "allowed_amount": 937.50, "providers": [{ "billed_charge": 137228.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 34.11, "providers": [{ "billed_charge": 5837.60, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 75.40, "providers": [{ "billed_charge": 3345.00, "npi": [1992131734] } ] } ] } ] }, { "name": "DRUGS/INCIDNT RAD", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "255", "description": "PHARMACY - DRUGS INCIDENT TO RADIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 135.74, "providers": [{ "billed_charge": 994.40, "npi": [1154392231] } ] } ] } ] }, { "name": "IV THERAPY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "260", "description": "IV THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2084.80, "providers": [{ "billed_charge": 3413.00, "npi": [1760480503] } ] }, { "allowed_amount": 5373.00, "providers": [{ "billed_charge": 7063.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16914.43, "providers": [{ "billed_charge": 67000.00, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1960.83, "providers": [{ "billed_charge": 8830.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "851516898" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14554.67, "providers": [{ "billed_charge": 54163.40, "npi": [1518539048] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6272.54, "providers": [{ "billed_charge": 35643.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 55823.68, "providers": [{ "billed_charge": 179679.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 523.95, "providers": [{ "billed_charge": 523.95, "npi": [1083643738] } ] }, { "allowed_amount": 1460.46, "providers": [{ "billed_charge": 1460.46, "npi": [1083643738] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18909.61, "providers": [{ "billed_charge": 45613.00, "npi": [1992131734] } ] } ] } ] }, { "name": "IV THERAPY/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "269", "description": "IV THERAPY - OTHER IV THERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "862195601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1183.97, "providers": [{ "billed_charge": 3875.20, "npi": [1881352037] } ] } ] } ] }, { "name": "STERILE SUPPLY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "272", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1579.21, "providers": [{ "billed_charge": 5264.06, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 360.00, "providers": [{ "billed_charge": 297508.00, "npi": [1982733655] } ] }, { "allowed_amount": 2331.00, "providers": [{ "billed_charge": 3108.00, "npi": [1982733655] } ] }, { "allowed_amount": 492.51, "providers": [{ "billed_charge": 11747.00, "npi": [1982733655] } ] } ] } ] }, { "name": "SUPPLY/IMPLANTS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "278", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 221.76, "providers": [{ "billed_charge": 1611.00, "npi": [1982733655] } ] } ] } ] }, { "name": "LABORATORY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "300", "description": "LABORATORY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 535.80, "providers": [{ "billed_charge": 893.00, "npi": [1760480503] } ] }, { "allowed_amount": 2458.80, "providers": [{ "billed_charge": 4098.00, "npi": [1760480503] } ] }, { "allowed_amount": 15980.20, "providers": [{ "billed_charge": 26633.66, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 98.56, "providers": [{ "billed_charge": 3416.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "900214335" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 531.04, "providers": [{ "billed_charge": 2222.00, "npi": [1194705202] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 335.36, "providers": [{ "billed_charge": 4484.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10039.55, "providers": [{ "billed_charge": 11867.28, "npi": [1083643738] } ] }, { "allowed_amount": 1591.50, "providers": [{ "billed_charge": 1591.50, "npi": [1083643738] } ] }, { "allowed_amount": 4267.23, "providers": [{ "billed_charge": 4267.23, "npi": [1083643738] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59.52, "providers": [{ "billed_charge": 878.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "473255211" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1087.34, "providers": [{ "billed_charge": 1363.00, "npi": [1265813075] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 60.75, "providers": [{ "billed_charge": 2747.00, "npi": [1992131734] } ] } ] }, { "tin": { "type": "ein", "value": "821703810" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3784.12, "providers": [{ "billed_charge": 21255.76, "npi": [1356818496] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1517.83, "providers": [{ "billed_charge": 7537.45, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 703.29, "providers": [{ "billed_charge": 7316.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 501.98, "providers": [{ "billed_charge": 3428.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "862195601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1125.64, "providers": [{ "billed_charge": 22391.33, "npi": [1881352037] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 760.50, "providers": [{ "billed_charge": 43023.00, "npi": [1982733655] } ] }, { "allowed_amount": 48.88, "providers": [{ "billed_charge": 469.00, "npi": [1609408665] } ] }, { "allowed_amount": 794.84, "providers": [{ "billed_charge": 19564.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32.29, "providers": [{ "billed_charge": 272.22, "npi": [0] } ] }, { "allowed_amount": 809.13, "providers": [{ "billed_charge": 28014.77, "npi": [0] } ] } ] } ] }, { "name": "LAB/CHEMISTRY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "LABORATORY - CHEMISTRY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31276.00, "providers": [{ "billed_charge": 51944.00, "npi": [1760480503] } ] }, { "allowed_amount": 59948.10, "providers": [{ "billed_charge": 97276.00, "npi": [1760480503] } ] }, { "allowed_amount": 200266.20, "providers": [{ "billed_charge": 376310.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2229.36, "providers": [{ "billed_charge": 64679.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2314.13, "providers": [{ "billed_charge": 91593.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1918.33, "providers": [{ "billed_charge": 32823.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2324.42, "providers": [{ "billed_charge": 82096.00, "npi": [1992131734] } ] } ] }, { "tin": { "type": "ein", "value": "370635502" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1925.01, "providers": [{ "billed_charge": 7761.00, "npi": [1982796181] } ] }, { "allowed_amount": 4802.00, "providers": [{ "billed_charge": 19999.00, "npi": [1982796181] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.00, "providers": [{ "billed_charge": 1914.00, "npi": [1114744752] } ] }, { "allowed_amount": 36.79, "providers": [{ "billed_charge": 96873.84, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 354.12, "providers": [{ "billed_charge": 2339.45, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "860098923" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3715.39, "providers": [{ "billed_charge": 10606.00, "npi": [1902897820] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3371.91, "providers": [{ "billed_charge": 206450.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "851516898" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1956.63, "providers": [{ "billed_charge": 84555.00, "npi": [1518539048] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 67.50, "providers": [{ "billed_charge": 90.00, "npi": [1700910189] } ] }, { "allowed_amount": 7241.42, "providers": [{ "billed_charge": 174340.00, "npi": [1700910189] } ] }, { "allowed_amount": 532.50, "providers": [{ "billed_charge": 452650.80, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12371.25, "providers": [{ "billed_charge": 670762.00, "npi": [1982733655] } ] }, { "allowed_amount": 559.75, "providers": [{ "billed_charge": 12446.00, "npi": [1265065445] } ] }, { "allowed_amount": 337.50, "providers": [{ "billed_charge": 450.00, "npi": [1982733655] } ] }, { "allowed_amount": 14050.58, "providers": [{ "billed_charge": 331374.09, "npi": [1982733655] } ] }, { "allowed_amount": 1460.24, "providers": [{ "billed_charge": 20698.00, "npi": [1609408665] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1376.63, "providers": [{ "billed_charge": 33062.25, "npi": [0] } ] }, { "allowed_amount": 437.50, "providers": [{ "billed_charge": 2913.71, "npi": [0] } ] } ] } ] }, { "name": "LAB/IMMUNOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "302", "description": "LABORATORY - IMMUNOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1061.30, "providers": [{ "billed_charge": 1750.00, "npi": [1760480503] } ] }, { "allowed_amount": 3330.60, "providers": [{ "billed_charge": 5551.00, "npi": [1760480503] } ] }, { "allowed_amount": 2016.10, "providers": [{ "billed_charge": 3257.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 268.50, "providers": [{ "billed_charge": 358.00, "npi": [1700910189] } ] }, { "allowed_amount": 54.97, "providers": [{ "billed_charge": 989.64, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 176.31, "providers": [{ "billed_charge": 5939.00, "npi": [1982733655] } ] }, { "allowed_amount": 555.00, "providers": [{ "billed_charge": 15762.00, "npi": [1982733655] } ] } ] } ] }, { "name": "LAB/HEMATOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "305", "description": "LABORATORY - HEMATOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16147.20, "providers": [{ "billed_charge": 26612.00, "npi": [1760480503] } ] }, { "allowed_amount": 10174.20, "providers": [{ "billed_charge": 18066.00, "npi": [1760480503] } ] }, { "allowed_amount": 6788.60, "providers": [{ "billed_charge": 11289.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 438.50, "providers": [{ "billed_charge": 9588.36, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 446.64, "providers": [{ "billed_charge": 29140.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 303.52, "providers": [{ "billed_charge": 303.52, "npi": [1083643738] } ] }, { "allowed_amount": 43.36, "providers": [{ "billed_charge": 43.36, "npi": [1083643738] } ] }, { "allowed_amount": 44.82, "providers": [{ "billed_charge": 44.82, "npi": [1083643738] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 435.32, "providers": [{ "billed_charge": 4185.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 286.20, "providers": [{ "billed_charge": 15382.00, "npi": [1992131734] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9.19, "providers": [{ "billed_charge": 685.00, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "860098923" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 241.80, "providers": [{ "billed_charge": 880.00, "npi": [1902897820] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 435.29, "providers": [{ "billed_charge": 2881.66, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 689.85, "providers": [{ "billed_charge": 65916.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "851516898" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 661.22, "providers": [{ "billed_charge": 38377.00, "npi": [1518539048] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1355.69, "providers": [{ "billed_charge": 26754.00, "npi": [1700910189] } ] }, { "allowed_amount": 196.50, "providers": [{ "billed_charge": 262.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "862195601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 49.57, "providers": [{ "billed_charge": 1571.71, "npi": [1881352037] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2421.92, "providers": [{ "billed_charge": 85342.00, "npi": [1982733655] } ] }, { "allowed_amount": 87.34, "providers": [{ "billed_charge": 2268.00, "npi": [1609408665] } ] }, { "allowed_amount": 425.25, "providers": [{ "billed_charge": 567.00, "npi": [1982733655] } ] }, { "allowed_amount": 4350.00, "providers": [{ "billed_charge": 203775.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 170.16, "providers": [{ "billed_charge": 4532.00, "npi": [0] } ] }, { "allowed_amount": 22.29, "providers": [{ "billed_charge": 237.18, "npi": [0] } ] } ] } ] }, { "name": "LAB/BACT-MIRCO", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "306", "description": "LABORATORY - BACTERIOLOGY & MICROBIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 497.90, "providers": [{ "billed_charge": 4065.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 66170.40, "providers": [{ "billed_charge": 125987.00, "npi": [1760480503] } ] }, { "allowed_amount": 23964.00, "providers": [{ "billed_charge": 39940.00, "npi": [1760480503] } ] }, { "allowed_amount": 18143.20, "providers": [{ "billed_charge": 28818.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5663.24, "providers": [{ "billed_charge": 27876.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1209.86, "providers": [{ "billed_charge": 4733.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1390.58, "providers": [{ "billed_charge": 10419.00, "npi": [1992131734] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1012.65, "providers": [{ "billed_charge": 9040.00, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "860098923" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 234.54, "providers": [{ "billed_charge": 292.00, "npi": [1902897820] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 176.23, "providers": [{ "billed_charge": 319.70, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8881.80, "providers": [{ "billed_charge": 54021.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "851516898" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1561.24, "providers": [{ "billed_charge": 6265.00, "npi": [1518539048] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3148.50, "providers": [{ "billed_charge": 4198.00, "npi": [1700910189] } ] }, { "allowed_amount": 1614.39, "providers": [{ "billed_charge": 6844.72, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7403.11, "providers": [{ "billed_charge": 87958.00, "npi": [1982733655] } ] }, { "allowed_amount": 2408.25, "providers": [{ "billed_charge": 144475.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 104.33, "providers": [{ "billed_charge": 311.65, "npi": [0] } ] }, { "allowed_amount": 68.21, "providers": [{ "billed_charge": 286.23, "npi": [0] } ] } ] } ] }, { "name": "LAB/UROLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "307", "description": "LABORATORY - UROLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1828.40, "providers": [{ "billed_charge": 3034.00, "npi": [1760480503] } ] }, { "allowed_amount": 642.60, "providers": [{ "billed_charge": 1071.00, "npi": [1760480503] } ] }, { "allowed_amount": 478.20, "providers": [{ "billed_charge": 797.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24.20, "providers": [{ "billed_charge": 406.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 558.04, "providers": [{ "billed_charge": 47859.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1197.75, "providers": [{ "billed_charge": 1694.00, "npi": [1700910189] } ] }, { "allowed_amount": 38.62, "providers": [{ "billed_charge": 4129.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 307.88, "providers": [{ "billed_charge": 22918.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 653.99, "providers": [{ "billed_charge": 27843.00, "npi": [1982733655] } ] }, { "allowed_amount": 246.00, "providers": [{ "billed_charge": 10888.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 235.41, "providers": [{ "billed_charge": 276.09, "npi": [1083643738] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.69, "providers": [{ "billed_charge": 160.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 114.74, "providers": [{ "billed_charge": 1103.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36.62, "providers": [{ "billed_charge": 3623.00, "npi": [1992131734] } ] } ] } ] }, { "name": "LAB/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "309", "description": "LABORATORY - OTHER LABORATORY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14.77, "providers": [{ "billed_charge": 192.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 66.33, "providers": [{ "billed_charge": 1759.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4871.25, "providers": [{ "billed_charge": 65205.00, "npi": [1982733655] } ] }, { "allowed_amount": 691.50, "providers": [{ "billed_charge": 922.00, "npi": [1982733655] } ] }, { "allowed_amount": 181.99, "providers": [{ "billed_charge": 12142.00, "npi": [1982733655] } ] } ] } ] }, { "name": "PATHOL/HYSTOL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "312", "description": "LABORATORY PATHOLOGICAL - HISTOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 660.00, "providers": [{ "billed_charge": 1100.00, "npi": [1760480503] } ] }, { "allowed_amount": 7216.80, "providers": [{ "billed_charge": 12028.00, "npi": [1760480503] } ] } ] } ] }, { "name": "DX X-RAY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "320", "description": "RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16740.40, "providers": [{ "billed_charge": 27532.00, "npi": [1760480503] } ] }, { "allowed_amount": 3642.00, "providers": [{ "billed_charge": 6531.00, "npi": [1760480503] } ] }, { "allowed_amount": 22507.80, "providers": [{ "billed_charge": 37513.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 836.18, "providers": [{ "billed_charge": 68768.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1227.75, "providers": [{ "billed_charge": 1637.00, "npi": [1700910189] } ] }, { "allowed_amount": 410.58, "providers": [{ "billed_charge": 25088.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 381.26, "providers": [{ "billed_charge": 24478.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2581.83, "providers": [{ "billed_charge": 75225.55, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 115.98, "providers": [{ "billed_charge": 115.98, "npi": [1083643738] } ] }, { "allowed_amount": 479.11, "providers": [{ "billed_charge": 479.11, "npi": [1083643738] } ] } ] } ] }, { "name": "DX X-RAY/CHEST", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "324", "description": "RADIOLOGY - DIAGNOSTIC - CHEST X-RAY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8410.50, "providers": [{ "billed_charge": 13924.00, "npi": [1760480503] } ] }, { "allowed_amount": 3171.60, "providers": [{ "billed_charge": 5286.00, "npi": [1760480503] } ] }, { "allowed_amount": 11503.20, "providers": [{ "billed_charge": 19172.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1332.70, "providers": [{ "billed_charge": 7174.00, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3734.92, "providers": [{ "billed_charge": 11036.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15251.33, "providers": [{ "billed_charge": 48859.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 171.00, "providers": [{ "billed_charge": 228.00, "npi": [1700910189] } ] }, { "allowed_amount": 8229.95, "providers": [{ "billed_charge": 23048.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6424.46, "providers": [{ "billed_charge": 21395.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14695.08, "providers": [{ "billed_charge": 46978.00, "npi": [1982733655] } ] }, { "allowed_amount": 422.25, "providers": [{ "billed_charge": 58703.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2228.04, "providers": [{ "billed_charge": 1980.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1623.72, "providers": [{ "billed_charge": 3941.00, "npi": [1992131734] } ] } ] } ] }, { "name": "CT SCAN/HEAD", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "351", "description": "CT SCAN - HEAD SCAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3557.38, "providers": [{ "billed_charge": 36386.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8277.60, "providers": [{ "billed_charge": 113188.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8326.56, "providers": [{ "billed_charge": 71001.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2053.10, "providers": [{ "billed_charge": 25589.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31225.89, "providers": [{ "billed_charge": 245178.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1818.98, "providers": [{ "billed_charge": 13284.00, "npi": [1992131734] } ] } ] } ] }, { "name": "CT SCAN/BODY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "352", "description": "CT SCAN - BODY SCAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860181654" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3860.23, "providers": [{ "billed_charge": 67564.00, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11473.32, "providers": [{ "billed_charge": 118563.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 63423.19, "providers": [{ "billed_charge": 605651.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25551.73, "providers": [{ "billed_charge": 287829.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31154.82, "providers": [{ "billed_charge": 305851.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 52627.58, "providers": [{ "billed_charge": 697133.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7174.57, "providers": [{ "billed_charge": 26148.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12277.49, "providers": [{ "billed_charge": 131954.00, "npi": [1992131734] } ] } ] } ] }, { "name": "OR SERVICES", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "360", "description": "OPERATING ROOM SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18441.00, "providers": [{ "billed_charge": 30735.00, "npi": [1760480503] } ] }, { "allowed_amount": 124218.00, "providers": [{ "billed_charge": 207030.00, "npi": [1760480503] } ] }, { "allowed_amount": 163266.00, "providers": [{ "billed_charge": 272110.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7696.08, "providers": [{ "billed_charge": 14252.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15980.04, "providers": [{ "billed_charge": 43976.00, "npi": [1982733655] } ] } ] } ] }, { "name": "OR/MINOR", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "361", "description": "OPERATING ROOM SERVICES - MINOR SURGERY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39000.00, "providers": [{ "billed_charge": 65000.00, "npi": [1760480503] } ] }, { "allowed_amount": 4546.20, "providers": [{ "billed_charge": 7577.00, "npi": [1760480503] } ] } ] } ] }, { "name": "ROUTINE VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203134104" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.00, "providers": [{ "billed_charge": 59.20, "npi": [1073578159, 1033166012] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5343.59, "providers": [{ "billed_charge": 76529.09, "npi": [1740262880] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.37, "providers": [{ "billed_charge": 385.99, "npi": [1538144910] } ] } ] } ] }, { "name": "ANESTHESIA", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "370", "description": "ANESTHESIA - GENERAL CLASSIFICATIION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43599.00, "providers": [{ "billed_charge": 72665.00, "npi": [1760480503] } ] }, { "allowed_amount": 5703.00, "providers": [{ "billed_charge": 9505.00, "npi": [1760480503] } ] }, { "allowed_amount": 49017.50, "providers": [{ "billed_charge": 80455.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 941.92, "providers": [{ "billed_charge": 21660.00, "npi": [1982733655] } ] }, { "allowed_amount": 3519.75, "providers": [{ "billed_charge": 155390.00, "npi": [1982733655] } ] }, { "allowed_amount": 5280.75, "providers": [{ "billed_charge": 7041.00, "npi": [1982733655] } ] } ] } ] }, { "name": "ULTRASOUND", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "402", "description": "OTHER IMAGING SERVICES - ULTRASOUND", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6239.40, "providers": [{ "billed_charge": 11300.00, "npi": [1760480503] } ] }, { "allowed_amount": 10830.60, "providers": [{ "billed_charge": 18051.00, "npi": [1760480503] } ] }, { "allowed_amount": 12255.00, "providers": [{ "billed_charge": 20425.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 280.14, "providers": [{ "billed_charge": 1918.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4099.67, "providers": [{ "billed_charge": 34848.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 980.49, "providers": [{ "billed_charge": 8007.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7390.70, "providers": [{ "billed_charge": 56049.00, "npi": [1982733655] } ] } ] } ] }, { "name": "RESPIRATORY SVC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "410", "description": "RESPIRATORY SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 315.00, "providers": [{ "billed_charge": 525.00, "npi": [1760480503] } ] } ] } ] }, { "name": "INHALATION SVC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "412", "description": "RESPIRATORY SERVICES - INHALATION SERVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 120.43, "providers": [{ "billed_charge": 3456.00, "npi": [1982733655] } ] } ] } ] }, { "name": "PHYSICAL THERP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "420", "description": "PHYSICAL THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1092.00, "providers": [{ "billed_charge": 1820.00, "npi": [1760480503] } ] }, { "allowed_amount": 8310.60, "providers": [{ "billed_charge": 13851.00, "npi": [1760480503] } ] } ] } ] }, { "name": "OCCUP THERP/EVAL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "434", "description": "OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561134" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 441.00, "providers": [{ "billed_charge": 9890.00, "npi": [1982733655] } ] } ] } ] }, { "name": "SPEECH PATHOL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "440", "description": "SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4027.20, "providers": [{ "billed_charge": 6712.00, "npi": [1760480503] } ] } ] } ] }, { "name": "EMERG ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "450", "description": "EMERGENCY ROOM - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 511141.30, "providers": [{ "billed_charge": 850253.00, "npi": [1760480503] } ] }, { "allowed_amount": 74724.00, "providers": [{ "billed_charge": 124540.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 132011.59, "providers": [{ "billed_charge": 417460.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 322493.43, "providers": [{ "billed_charge": 991312.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1512.00, "providers": [{ "billed_charge": 1512.00, "npi": [1083643738] } ] }, { "allowed_amount": 25945.20, "providers": [{ "billed_charge": 25945.20, "npi": [1083643738] } ] } ] }, { "tin": { "type": "ein", "value": "473255211" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 297.00, "providers": [{ "billed_charge": 297.00, "npi": [1265813075] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 116502.89, "providers": [{ "billed_charge": 282443.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 94263.26, "providers": [{ "billed_charge": 294799.00, "npi": [1992131734] } ] } ] }, { "tin": { "type": "ein", "value": "821703810" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3415.18, "providers": [{ "billed_charge": 15579.23, "npi": [1356818496] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 69718.91, "providers": [{ "billed_charge": 369381.00, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "860098923" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22173.59, "providers": [{ "billed_charge": 37343.00, "npi": [1902897820] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 67928.79, "providers": [{ "billed_charge": 249364.25, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "851516898" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 79871.73, "providers": [{ "billed_charge": 167110.00, "npi": [1518539048] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 573068.49, "providers": [{ "billed_charge": 1752475.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "862195601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18684.40, "providers": [{ "billed_charge": 78336.18, "npi": [1881352037] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 205034.55, "providers": [{ "billed_charge": 677947.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 391186.91, "providers": [{ "billed_charge": 1136379.00, "npi": [1982733655] } ] }, { "allowed_amount": 81611.57, "providers": [{ "billed_charge": 135066.00, "npi": [1609408665] } ] }, { "allowed_amount": 59920.35, "providers": [{ "billed_charge": 91263.00, "npi": [1265065445] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16393.45, "providers": [{ "billed_charge": 157641.60, "npi": [0] } ] } ] } ] }, { "name": "URGENT CARE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "456", "description": "EMERGENCY ROOM - URGENT CARE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561132" }, "service_code": ["20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5804.85, "providers": [{ "billed_charge": 7791.60, "npi": [1700910189] } ] } ] } ] }, { "name": "PULMONARY FUNC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "460", "description": "PULMONARY FUNCTION - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1239.00, "providers": [{ "billed_charge": 2065.00, "npi": [1760480503] } ] } ] } ] }, { "name": "AUDIOLOGY/DX", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "471", "description": "AUDIOLOGY - DIAGNOSTIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3939.00, "providers": [{ "billed_charge": 6565.00, "npi": [1760480503] } ] } ] } ] }, { "name": "ECHOCARDIOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "483", "description": "CARDIOLOGY - ECHOCARDIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5729.40, "providers": [{ "billed_charge": 9549.00, "npi": [1760480503] } ] }, { "allowed_amount": 31223.40, "providers": [{ "billed_charge": 85720.00, "npi": [1760480503] } ] }, { "allowed_amount": 35638.80, "providers": [{ "billed_charge": 59398.00, "npi": [1760480503] } ] } ] } ] }, { "name": "MRA - Head and Neck", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "615", "description": "MRA - Head and Neck", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1094.14, "providers": [{ "billed_charge": 11482.00, "npi": [1982733655] } ] } ] } ] }, { "name": "DRUG/DETAIL CODE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "636", "description": "DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 127560.00, "providers": [{ "billed_charge": 323231.00, "npi": [1760480503] } ] }, { "allowed_amount": 34023.00, "providers": [{ "billed_charge": 55485.00, "npi": [1760480503] } ] }, { "allowed_amount": 5626.80, "providers": [{ "billed_charge": 9375.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1109.83, "providers": [{ "billed_charge": 52530.20, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1696.25, "providers": [{ "billed_charge": 113017.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "850105601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 212.10, "providers": [{ "billed_charge": 707.00, "npi": [1215913470] } ] } ] }, { "tin": { "type": "ein", "value": "860212139" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1339.61, "providers": [{ "billed_charge": 1339.61, "npi": [1083643738] } ] }, { "allowed_amount": 884.05, "providers": [{ "billed_charge": 1618.21, "npi": [1083643738] } ] }, { "allowed_amount": 367.06, "providers": [{ "billed_charge": 367.06, "npi": [1083643738] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.63, "providers": [{ "billed_charge": 12.09, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 670.15, "providers": [{ "billed_charge": 9191.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14073.54, "providers": [{ "billed_charge": 31411.24, "npi": [1992131734] } ] } ] }, { "tin": { "type": "ein", "value": "821703810" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1171.07, "providers": [{ "billed_charge": 5436.52, "npi": [1356818496] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.00, "providers": [{ "billed_charge": 13866.00, "npi": [1114744752] } ] }, { "allowed_amount": 230.20, "providers": [{ "billed_charge": 38711.80, "npi": [1114744752] } ] } ] }, { "tin": { "type": "ein", "value": "860098923" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 707.94, "providers": [{ "billed_charge": 1361.00, "npi": [1902897820] } ] } ] }, { "tin": { "type": "ein", "value": "833547294" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5801.87, "providers": [{ "billed_charge": 19337.45, "npi": [1609496397] } ] } ] }, { "tin": { "type": "ein", "value": "851516898" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2483.98, "providers": [{ "billed_charge": 38823.01, "npi": [1518539048] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2041.02, "providers": [{ "billed_charge": 178498.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23", "20", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 249.00, "providers": [{ "billed_charge": 332.00, "npi": [1700910189] } ] }, { "allowed_amount": 529.50, "providers": [{ "billed_charge": 803863.00, "npi": [1700910189] } ] }, { "allowed_amount": 2883.75, "providers": [{ "billed_charge": 105798.25, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "862195601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 350.08, "providers": [{ "billed_charge": 9484.10, "npi": [1881352037] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 417.16, "providers": [{ "billed_charge": 5699.00, "npi": [1609408665] } ] }, { "allowed_amount": 8141.25, "providers": [{ "billed_charge": 10855.00, "npi": [1982733655] } ] }, { "allowed_amount": 13657.95, "providers": [{ "billed_charge": 46558.00, "npi": [1982733655] } ] }, { "allowed_amount": 110.82, "providers": [{ "billed_charge": 1143.00, "npi": [1265065445] } ] }, { "allowed_amount": 4722.00, "providers": [{ "billed_charge": 369125.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "550261260" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.60, "providers": [{ "billed_charge": 42.00, "npi": [1629015698] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 122.86, "providers": [{ "billed_charge": 2454.31, "npi": [0] } ] } ] } ] }, { "name": "RECOVERY ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "710", "description": "RECOVERY ROOM - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14205.00, "providers": [{ "billed_charge": 23675.00, "npi": [1760480503] } ] }, { "allowed_amount": 27543.00, "providers": [{ "billed_charge": 45905.00, "npi": [1760480503] } ] }, { "allowed_amount": 72111.50, "providers": [{ "billed_charge": 119620.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5013.75, "providers": [{ "billed_charge": 60159.00, "npi": [1982733655] } ] } ] } ] }, { "name": "EKG/ECG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "730", "description": "EKG/ECG - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "352263845" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 213.98, "providers": [{ "billed_charge": 22196.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "860422559" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4432.65, "providers": [{ "billed_charge": 7634.00, "npi": [1760480503] } ] }, { "allowed_amount": 7978.80, "providers": [{ "billed_charge": 13298.00, "npi": [1760480503] } ] }, { "allowed_amount": 1773.00, "providers": [{ "billed_charge": 16745.00, "npi": [1760480503] } ] } ] }, { "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 362.90, "providers": [{ "billed_charge": 58717.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1233.88, "providers": [{ "billed_charge": 45824.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72.58, "providers": [{ "billed_charge": 18194.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1907.32, "providers": [{ "billed_charge": 59301.00, "npi": [1982733655] } ] } ] }, { "tin": { "type": "ein", "value": "571165217" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 62.33, "providers": [{ "billed_charge": 734.00, "npi": [0] } ] }, { "allowed_amount": 37.18, "providers": [{ "billed_charge": 189.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72.58, "providers": [{ "billed_charge": 6116.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "463533638" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72.58, "providers": [{ "billed_charge": 7188.00, "npi": [1992131734] } ] } ] } ] }, { "name": "OBSERVATION ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "762", "description": "TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 693.94, "providers": [{ "billed_charge": 8672.00, "npi": [1700910189] } ] } ] } ] }, { "name": "BREAST TOMOSYNTHESIS BI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77063", "description": "SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200382536" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1546.56, "providers": [{ "billed_charge": 7564.00, "npi": [1154558039] } ] } ] } ] }, { "name": "SCR MAMMO BI INCL CAD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77067", "description": "SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200382536" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3777.04, "providers": [{ "billed_charge": 18290.00, "npi": [1154558039] } ] } ] } ] }, { "name": "VACCINE ADMIN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "771", "description": "PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561134" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 178.50, "providers": [{ "billed_charge": 714.00, "npi": [1982733655] } ] } ] } ] }, { "name": "METABOLIC PANEL TOTAL CA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 615.60, "providers": [{ "billed_charge": 4383.15, "npi": [1740262880] } ] } ] } ] }, { "name": "GENERAL HEALTH PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80050", "description": "GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 772.80, "providers": [{ "billed_charge": 4639.91, "npi": [1740262880] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80053", "description": "COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32246.05, "providers": [{ "billed_charge": 203831.12, "npi": [1740262880] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.50, "providers": [{ "billed_charge": 235.30, "npi": [1234567893] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80061", "description": "LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29156.53, "providers": [{ "billed_charge": 289638.91, "npi": [1740262880] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80069", "description": "RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 133.00, "providers": [{ "billed_charge": 987.51, "npi": [1740262880] } ] } ] } ] }, { "name": "ACUTE HEPATITIS PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80074", "description": "ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6649.72, "providers": [{ "billed_charge": 87640.24, "npi": [1740262880] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80076", "description": "HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 194.06, "providers": [{ "billed_charge": 1469.29, "npi": [1740262880] } ] } ] } ] }, { "name": "DRUG TEST PRSMV DIR OPT OBS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80305", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870847992" }, "service_code": ["11", "99"], "billing_class": "professional", "payments": [{ "allowed_amount": 107.10, "providers": [{ "billed_charge": 535.50, "npi": [1871547380] } ] }, { "allowed_amount": 12.60, "providers": [{ "billed_charge": 63.00, "npi": [1871547380] } ] } ] } ] }, { "name": "DRUG TEST PRSMV INSTRMNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80306", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; READ BY ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "454995568" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 300.78, "providers": [{ "billed_charge": 550.00, "npi": [1891971628] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80307", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1217.44, "providers": [{ "billed_charge": 2192.51, "npi": [1740262880] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1146.96, "providers": [{ "billed_charge": 17513.06, "npi": [1740262880] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81003", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.24, "providers": [{ "billed_charge": 3752.12, "npi": [1740262880] } ] } ] } ] }, { "name": "URINE PREGNANCY TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81025", "description": "URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870847992" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.55, "providers": [{ "billed_charge": 172.50, "npi": [1871547380] } ] } ] } ] }, { "name": "CFTR GENE COM VARIANTS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81220", "description": "CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "10894487" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9114.14, "providers": [{ "billed_charge": 52500.00, "npi": [1558672279] } ] } ] } ] }, { "name": "SMN1 GENE DOS/DELETION ALYS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81329", "description": "SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "10894487" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1848.16, "providers": [{ "billed_charge": 3000.00, "npi": [1558672279] } ] } ] } ] }, { "name": "MOPATH PROCEDURE LEVEL 9", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81408", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 9", "allowed_amounts": [{ "tin": { "type": "ein", "value": "10894487" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22199.78, "providers": [{ "billed_charge": 29300.00, "npi": [1558672279] } ] } ] } ] }, { "name": "FETAL CHRMOML ANEUPLOIDY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81420", "description": "FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16485.61, "providers": [{ "billed_charge": 28594.41, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF ACTH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82024", "description": "ADRENOCORTICOTROPIC HORMONE (ACTH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 88.80, "providers": [{ "billed_charge": 837.90, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF SERUM ALBUMIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82040", "description": "ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 597.26, "providers": [{ "billed_charge": 1160.53, "npi": [1740262880] } ] } ] } ] }, { "name": "MICROALBUMIN, QUANTITATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82043", "description": "ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2823.84, "providers": [{ "billed_charge": 47011.11, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF BREATH ETHANOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82075", "description": "ALCOHOL (ETHANOL), BREATH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870847992" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 285.00, "providers": [{ "billed_charge": 855.00, "npi": [1871547380] } ] } ] }, { "tin": { "type": "ein", "value": "237086112" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 486.00, "providers": [{ "billed_charge": 1078.92, "npi": [1477016921] } ] } ] } ] }, { "name": "ALPHA-FETOPROTEIN, SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82105", "description": "ALPHA-FETOPROTEIN (AFP); SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 161.92, "providers": [{ "billed_charge": 1903.90, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF AMYLASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82150", "description": "AMYLASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.31, "providers": [{ "billed_charge": 1368.65, "npi": [1740262880] } ] } ] } ] }, { "name": "chemistry test for anti-mullerian hormone (AMH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82166", "description": "chemistry test for anti-mullerian hormone (AMH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 144.62, "providers": [{ "billed_charge": 904.05, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF APOLIPOPROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82172", "description": "APOLIPOPROTEIN, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 783.42, "providers": [{ "billed_charge": 2437.77, "npi": [1740262880] } ] } ] } ] }, { "name": "BILIRUBIN, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82247", "description": "BILIRUBIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 578.44, "providers": [{ "billed_charge": 714.64, "npi": [1740262880] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 168.00, "providers": [{ "billed_charge": 334.28, "npi": [1740262880] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30899.79, "providers": [{ "billed_charge": 509485.40, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF CALCIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82310", "description": "CALCIUM; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 565.09, "providers": [{ "billed_charge": 835.08, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF CALCIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82330", "description": "CALCIUM; IONIZED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 92.43, "providers": [{ "billed_charge": 957.55, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY, BLOOD CARBON DIOXIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82374", "description": "CARBON DIOXIDE (BICARBONATE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 178.05, "providers": [{ "billed_charge": 184.35, "npi": [1740262880] } ] } ] } ] }, { "name": "CARCINOEMBRYONIC ANTIGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82378", "description": "CARCINOEMBRYONIC ANTIGEN (CEA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 392.58, "providers": [{ "billed_charge": 3721.17, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF BLOOD CHLORIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82435", "description": "CHLORIDE; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 490.36, "providers": [{ "billed_charge": 587.44, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF COPPER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82525", "description": "COPPER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.08, "providers": [{ "billed_charge": 791.05, "npi": [1740262880] } ] } ] } ] }, { "name": "TOTAL CORTISOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82533", "description": "CORTISOL; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2335.63, "providers": [{ "billed_charge": 21794.36, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF CK (CPK)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82550", "description": "CREATINE KINASE (CK), (CPK); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 149.70, "providers": [{ "billed_charge": 1276.30, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF CREATININE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82565", "description": "CREATININE; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 629.25, "providers": [{ "billed_charge": 1361.05, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2463.14, "providers": [{ "billed_charge": 39846.61, "npi": [1740262880] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8396.85, "providers": [{ "billed_charge": 78064.75, "npi": [1740262880] } ] } ] } ] }, { "name": "DEHYDROEPIANDROSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82626", "description": "DEHYDROEPIANDROSTERONE (DHEA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.96, "providers": [{ "billed_charge": 1820.43, "npi": [1740262880] } ] } ] } ] }, { "name": "DEHYDROEPIANDROSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82627", "description": "DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4021.44, "providers": [{ "billed_charge": 41479.68, "npi": [1740262880] } ] } ] } ] }, { "name": "DIHYDROTESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82642", "description": "DIHYDROTESTOSTERONE (DHT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 269.16, "providers": [{ "billed_charge": 2271.56, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14087.78, "providers": [{ "billed_charge": 116993.98, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF ESTROGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82672", "description": "ESTROGENS; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1196.64, "providers": [{ "billed_charge": 12518.72, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF ESTRONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82679", "description": "ESTRONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1071.28, "providers": [{ "billed_charge": 11214.64, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5366.16, "providers": [{ "billed_charge": 45047.99, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5646.27, "providers": [{ "billed_charge": 52781.66, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 580.16, "providers": [{ "billed_charge": 11304.01, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF IGE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82785", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 277.64, "providers": [{ "billed_charge": 2613.97, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 275.55, "providers": [{ "billed_charge": 675.25, "npi": [1740262880] } ] } ] } ] }, { "name": "GLUCOSE TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82950", "description": "GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 538.72, "providers": [{ "billed_charge": 4585.73, "npi": [1740262880] } ] } ] } ] }, { "name": "GLUCOSE TOLERANCE TEST (GTT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82951", "description": "GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 127.30, "providers": [{ "billed_charge": 986.22, "npi": [1740262880] } ] } ] } ] }, { "name": "GTT-ADDED SAMPLES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82952", "description": "GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN ADDITION TO CODE FOR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 48.00, "providers": [{ "billed_charge": 277.39, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF GGT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82977", "description": "GLUTAMYLTRANSFERASE, GAMMA (GGT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 485.76, "providers": [{ "billed_charge": 3430.91, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6536.16, "providers": [{ "billed_charge": 55384.25, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5051.64, "providers": [{ "billed_charge": 42228.97, "npi": [1740262880] } ] } ] } ] }, { "name": "H PYLORI (C-13), BREATH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83013", "description": "HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3715.92, "providers": [{ "billed_charge": 24494.40, "npi": [1740262880] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19730.88, "providers": [{ "billed_charge": 206326.01, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF HOMOCYSTINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83090", "description": "HOMOCYSTEINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 879.24, "providers": [{ "billed_charge": 12925.00, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOASSAY NONANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83516", "description": "IMMUNOASSAY FOR ANALYTE OTH THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 265.16, "providers": [{ "billed_charge": 4370.68, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOASSAY QUANT NOS NONAB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83520", "description": "IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 734.04, "providers": [{ "billed_charge": 12327.90, "npi": [1740262880] } ] } ] } ] }, { "name": "IG LIGHT CHAINS FREE EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83521", "description": "IMMUNOGLOBULIN LIGHT CHAINS FREE EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.48, "providers": [{ "billed_charge": 309.75, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF INSULIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83525", "description": "INSULIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1019.07, "providers": [{ "billed_charge": 14008.92, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2631.02, "providers": [{ "billed_charge": 19583.32, "npi": [1740262880] } ] } ] } ] }, { "name": "IRON BINDING TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83550", "description": "IRON BINDING CAPACITY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3015.00, "providers": [{ "billed_charge": 22423.78, "npi": [1740262880] } ] } ] } ] }, { "name": "LACTATE (LD) (LDH) ENZYME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83615", "description": "LACTATE DEHYDROGENASE (LD), (LDH);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 398.16, "providers": [{ "billed_charge": 2310.29, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.52, "providers": [{ "billed_charge": 2045.10, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN(A)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83695", "description": "LIPOPROTEIN (A)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.72, "providers": [{ "billed_charge": 2585.33, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF BLOOD LIPOPROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83721", "description": "LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.55, "providers": [{ "billed_charge": 488.25, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 935.48, "providers": [{ "billed_charge": 8802.37, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF NATRIURETIC PEPTIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83880", "description": "NATRIURETIC PEPTIDE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.03, "providers": [{ "billed_charge": 723.45, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1929.43, "providers": [{ "billed_charge": 12495.47, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY ALKALINE PHOSPHATASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84075", "description": "PHOSPHATASE, ALKALINE;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 573.01, "providers": [{ "billed_charge": 667.36, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 385.42, "providers": [{ "billed_charge": 2778.18, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF SERUM POTASSIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84132", "description": "POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 247.82, "providers": [{ "billed_charge": 314.69, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PREGNENOLONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84140", "description": "PREGNENOLONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.20, "providers": [{ "billed_charge": 693.00, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6795.75, "providers": [{ "billed_charge": 61594.60, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2643.30, "providers": [{ "billed_charge": 23744.43, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4551.07, "providers": [{ "billed_charge": 38133.43, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PSA, FREE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84154", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 873.58, "providers": [{ "billed_charge": 6243.67, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84155", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 464.26, "providers": [{ "billed_charge": 976.51, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 151.74, "providers": [{ "billed_charge": 2100.67, "npi": [1740262880] } ] } ] } ] }, { "name": "PROTEIN E-PHORESIS, SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84165", "description": "PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 164.60, "providers": [{ "billed_charge": 1365.54, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN B-6", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84207", "description": "PYRIDOXAL PHOSPHATE (VITAMIN B-6)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.53, "providers": [{ "billed_charge": 200.55, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF SEX HORMONE GLOBUL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84270", "description": "SEX HORMONE BINDING GLOBULIN (SHBG)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1952.00, "providers": [{ "billed_charge": 17925.81, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF SERUM SODIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84295", "description": "SODIUM; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 516.93, "providers": [{ "billed_charge": 599.88, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF SOMATOMEDIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84305", "description": "SOMATOMEDIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 537.57, "providers": [{ "billed_charge": 10044.48, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF FREE TESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84402", "description": "TESTOSTERONE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12583.95, "providers": [{ "billed_charge": 119612.86, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16852.61, "providers": [{ "billed_charge": 157595.51, "npi": [1740262880] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.78, "providers": [{ "billed_charge": 184.78, "npi": [1538144910] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN B-1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84425", "description": "THIAMINE (VITAMIN B-1)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.89, "providers": [{ "billed_charge": 929.23, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF TOTAL THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84436", "description": "THYROXINE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 824.98, "providers": [{ "billed_charge": 7560.48, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8464.75, "providers": [{ "billed_charge": 128483.11, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32779.13, "providers": [{ "billed_charge": 312993.43, "npi": [1740262880] } ] } ] } ] }, { "name": "TRANSFERASE (AST) (SGOT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84450", "description": "TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 626.12, "providers": [{ "billed_charge": 1091.49, "npi": [1740262880] } ] } ] } ] }, { "name": "ALANINE AMINO (ALT) (SGPT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84460", "description": "TRANSFERASE; ALANINE AMINO (ALT) (SGPT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 332.31, "providers": [{ "billed_charge": 1020.67, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 381.81, "providers": [{ "billed_charge": 3644.02, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF THYROID (T3 OR T4)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84479", "description": "THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 327.36, "providers": [{ "billed_charge": 2985.09, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY, TRIIODOTHYRONINE (T3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84480", "description": "TRIIODOTHYRONINE T3; TOTAL (TT-3)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 369.58, "providers": [{ "billed_charge": 4252.88, "npi": [1740262880] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8458.48, "providers": [{ "billed_charge": 141409.53, "npi": [1740262880] } ] } ] } ] }, { "name": "T3 REVERSE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84482", "description": "TRIIODOTHYRONINE T3; REVERSE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 906.00, "providers": [{ "billed_charge": 17114.57, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF UREA NITROGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84520", "description": "UREA NITROGEN; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 462.33, "providers": [{ "billed_charge": 794.17, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 598.77, "providers": [{ "billed_charge": 5510.34, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN A", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84590", "description": "VITAMIN A", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.67, "providers": [{ "billed_charge": 409.48, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF ZINC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84630", "description": "ZINC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 148.41, "providers": [{ "billed_charge": 1715.49, "npi": [1740262880] } ] } ] } ] }, { "name": "ASSAY OF C-PEPTIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84681", "description": "C-PEPTIDE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 277.38, "providers": [{ "billed_charge": 2239.04, "npi": [1740262880] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1226.64, "providers": [{ "billed_charge": 8658.26, "npi": [1740262880] } ] } ] } ] }, { "name": "HEMATOCRIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85014", "description": "BLOOD COUNT; HEMATOCRIT (HCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.68, "providers": [{ "billed_charge": 640.51, "npi": [1740262880] } ] } ] } ] }, { "name": "HEMOGLOBIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85018", "description": "BLOOD COUNT; HEMOGLOBIN (HGB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.39, "providers": [{ "billed_charge": 376.54, "npi": [1740262880] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17414.24, "providers": [{ "billed_charge": 137544.87, "npi": [1740262880] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.76, "providers": [{ "billed_charge": 98.80, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85027", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 890.52, "providers": [{ "billed_charge": 7035.63, "npi": [1740262880] } ] } ] } ] }, { "name": "AUTOMATED RETICULOCYTE COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85045", "description": "BLOOD COUNT; RETICULOCYTE, AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.56, "providers": [{ "billed_charge": 311.32, "npi": [1740262880] } ] } ] } ] }, { "name": "PROTHROMBIN TIME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85610", "description": "PROTHROMBIN TIME;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 508.67, "providers": [{ "billed_charge": 6872.97, "npi": [1740262880] } ] } ] } ] }, { "name": "RBC SED RATE, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85652", "description": "SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 503.01, "providers": [{ "billed_charge": 8923.19, "npi": [1740262880] } ] } ] } ] }, { "name": "THROMBOPLASTIN TIME, PARTIAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85730", "description": "THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 501.40, "providers": [{ "billed_charge": 7091.50, "npi": [1740262880] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86038", "description": "ANTINUCLEAR ANTIBODIES (ANA);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1483.20, "providers": [{ "billed_charge": 16082.77, "npi": [1740262880] } ] } ] } ] }, { "name": "ANTISTREPTOLYSIN O, TITER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86060", "description": "ANTISTREPTOLYSIN 0; TITER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.20, "providers": [{ "billed_charge": 132.30, "npi": [1740262880] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-REACTIVE PROTEIN;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.88, "providers": [{ "billed_charge": 15436.78, "npi": [1740262880] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN, HS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86141", "description": "C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1488.00, "providers": [{ "billed_charge": 12366.43, "npi": [1740262880] } ] } ] } ] }, { "name": "CARDIOLIPIN ANTIBODY EA IG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86147", "description": "CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 233.96, "providers": [{ "billed_charge": 1359.42, "npi": [1740262880] } ] } ] } ] }, { "name": "CCP ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86200", "description": "CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 545.60, "providers": [{ "billed_charge": 6076.81, "npi": [1740262880] } ] } ] } ] }, { "name": "DNA ANTIBODY NATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86225", "description": "DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.37, "providers": [{ "billed_charge": 3226.24, "npi": [1740262880] } ] } ] } ] }, { "name": "NUCLEAR ANTIGEN ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86235", "description": "EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2186.42, "providers": [{ "billed_charge": 29179.75, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOASSAY, TUMOR, CA 15-3", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86300", "description": "IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 972.95, "providers": [{ "billed_charge": 10391.56, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOASSAY, TUMOR, CA 19-9", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86301", "description": "IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 63.80, "providers": [{ "billed_charge": 722.40, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOASSAY, TUMOR, CA 125", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86304", "description": "IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 287.10, "providers": [{ "billed_charge": 3244.50, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOASSAY INFECTIOUS AGENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86317", "description": "IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 229.79, "providers": [{ "billed_charge": 2010.84, "npi": [1740262880] } ] } ] } ] }, { "name": "IMMUNOFIX E-PHORESIS, SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86334", "description": "IMMUNOFIXATION ELECTROPHORESIS; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.72, "providers": [{ "billed_charge": 883.13, "npi": [1740262880] } ] } ] } ] }, { "name": "TISS TRNSGLTMNASE EA IG CLAS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86364", "description": "TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.85, "providers": [{ "billed_charge": 595.21, "npi": [1740262880] } ] } ] } ] }, { "name": "MICROSOMAL ANTIBODY EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86376", "description": "MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2358.46, "providers": [{ "billed_charge": 27035.76, "npi": [1740262880] } ] } ] } ] }, { "name": "RHEUMATOID FACTOR, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86431", "description": "RHEUMATOID FACTOR; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 448.05, "providers": [{ "billed_charge": 4917.78, "npi": [1740262880] } ] } ] } ] }, { "name": "TB TEST CELL IMMUN MEASURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86480", "description": "TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3419.28, "providers": [{ "billed_charge": 16933.69, "npi": [1740262880] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86592", "description": "SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2367.48, "providers": [{ "billed_charge": 24699.38, "npi": [1740262880] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86593", "description": "SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.48, "providers": [{ "billed_charge": 153.72, "npi": [1740262880] } ] } ] } ] }, { "name": "COCCIDIOIDES ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86635", "description": "ANTIBODY; COCCIDIOIDES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1362.45, "providers": [{ "billed_charge": 16746.12, "npi": [1740262880] } ] } ] } ] }, { "name": "EPSTEIN-BARR NUCLEAR ANTIGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86664", "description": "ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.72, "providers": [{ "billed_charge": 117.67, "npi": [1740262880] } ] } ] } ] }, { "name": "EPSTEIN-BARR CAPSID VCA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86665", "description": "ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.60, "providers": [{ "billed_charge": 537.77, "npi": [1740262880] } ] } ] } ] }, { "name": "HERPES SIMPLEX TYPE 1 TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86695", "description": "ANTIBODY; HERPES SIMPLEX, TYPE 1", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1759.14, "providers": [{ "billed_charge": 16018.37, "npi": [1740262880] } ] } ] } ] }, { "name": "HERPES SIMPLEX TYPE 2 TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86696", "description": "ANTIBODY; HERPES SIMPLEX, TYPE 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2877.02, "providers": [{ "billed_charge": 25880.98, "npi": [1740262880] } ] } ] } ] }, { "name": "HEP B CORE ANTIBODY, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86704", "description": "HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 673.79, "providers": [{ "billed_charge": 7432.12, "npi": [1740262880] } ] } ] } ] }, { "name": "HEP B CORE ANTIBODY, IGM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86705", "description": "HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.02, "providers": [{ "billed_charge": 120.40, "npi": [1740262880] } ] } ] } ] }, { "name": "HEP B SURFACE ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86706", "description": "HEPATITIS B SURFACE ANTIBODY (HBSAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 814.77, "providers": [{ "billed_charge": 9086.67, "npi": [1740262880] } ] } ] } ] }, { "name": "HEPATITIS A ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86708", "description": "HEPATITIS A ANTIBODY (HAAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 351.50, "providers": [{ "billed_charge": 3569.09, "npi": [1740262880] } ] } ] } ] }, { "name": "RUBELLA ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86762", "description": "ANTIBODY; RUBELLA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1709.65, "providers": [{ "billed_charge": 10391.94, "npi": [1740262880] } ] } ] } ] }, { "name": "TREPONEMA PALLIDUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86780", "description": "ANTIBODY; TREPONEMA PALLIDUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 375.55, "providers": [{ "billed_charge": 3570.21, "npi": [1740262880] } ] } ] } ] }, { "name": "VARICELLA-ZOSTER ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86787", "description": "ANTIBODY; VARICELLA-ZOSTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 177.81, "providers": [{ "billed_charge": 2095.65, "npi": [1740262880] } ] } ] } ] }, { "name": "THYROGLOBULIN ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86800", "description": "THYROGLOBULIN ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1256.95, "providers": [{ "billed_charge": 14590.43, "npi": [1740262880] } ] } ] } ] }, { "name": "HEPATITIS C AB TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86803", "description": "HEPATITIS C ANTIBODY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3971.22, "providers": [{ "billed_charge": 34882.34, "npi": [1740262880] } ] } ] } ] }, { "name": "RBC ANTIBODY SCREEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86850", "description": "ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1229.05, "providers": [{ "billed_charge": 10823.66, "npi": [1740262880] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC ABO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86900", "description": "BLOOD TYPING, SEROLOGIC; ABO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 531.24, "providers": [{ "billed_charge": 4846.84, "npi": [1740262880] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC RH(D)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86901", "description": "BLOOD TYPING, SEROLOGIC; RH (D)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 528.96, "providers": [{ "billed_charge": 4935.25, "npi": [1740262880] } ] } ] } ] }, { "name": "CULTURE OTHR SPECIMN AEROBIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87070", "description": "CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 257.40, "providers": [{ "billed_charge": 3594.23, "npi": [1740262880] } ] } ] } ] }, { "name": "CULTR BACTERIA, EXCEPT BLOOD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87075", "description": "CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.75, "providers": [{ "billed_charge": 883.02, "npi": [1740262880] } ] } ] } ] }, { "name": "CULTURE AEROBIC IDENTIFY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87077", "description": "CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 612.81, "providers": [{ "billed_charge": 2433.15, "npi": [1740262880] } ] } ] } ] }, { "name": "CULTURE SCREEN ONLY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87081", "description": "CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 838.21, "providers": [{ "billed_charge": 6867.07, "npi": [1740262880] } ] } ] } ] }, { "name": "URINE CULTURE/COLONY COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87086", "description": "CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5397.68, "providers": [{ "billed_charge": 45390.21, "npi": [1740262880] } ] } ] } ] }, { "name": "URINE BACTERIA CULTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87088", "description": "CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1540.08, "providers": [{ "billed_charge": 7092.03, "npi": [1740262880] } ] } ] } ] }, { "name": "DNA/RNA AMPLIFIED PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87150", "description": "CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2554.56, "providers": [{ "billed_charge": 10284.55, "npi": [1740262880] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE MIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87186", "description": "SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1522.71, "providers": [{ "billed_charge": 18278.05, "npi": [1740262880] } ] } ] } ] }, { "name": "HEPATITIS B SURFACE AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87340", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2422.21, "providers": [{ "billed_charge": 23513.86, "npi": [1740262880] } ] } ] } ] }, { "name": "HIV-1 AG W/HIV-1 & HIV-2 AB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87389", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9389.25, "providers": [{ "billed_charge": 81202.84, "npi": [1740262880] } ] } ] } ] }, { "name": "CANDIDA, DNA, DIR PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87480", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 461.10, "providers": [{ "billed_charge": 2941.65, "npi": [1740262880] } ] } ] } ] }, { "name": "CHYLMD TRACH, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87491", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30001.45, "providers": [{ "billed_charge": 119126.09, "npi": [1740262880] } ] } ] } ] }, { "name": "GARDNER VAG, DNA, DIR PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87510", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 461.10, "providers": [{ "billed_charge": 2873.00, "npi": [1740262880] } ] } ] } ] }, { "name": "HEPATITIS C REVRS TRNSCRPJ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87522", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 393.84, "providers": [{ "billed_charge": 6423.10, "npi": [1740262880] } ] } ] } ] }, { "name": "HSV, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87529", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.78, "providers": [{ "billed_charge": 781.20, "npi": [1740262880] } ] } ] } ] }, { "name": "M. GENITALIUM AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87563", "description": "IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2070.53, "providers": [{ "billed_charge": 6666.26, "npi": [1740262880] } ] } ] } ] }, { "name": "N.GONORRHOEAE, DNA, AMP PROB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87591", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30055.24, "providers": [{ "billed_charge": 119886.28, "npi": [1740262880] } ] } ] } ] }, { "name": "HPV HIGH-RISK TYPES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87624", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21082.40, "providers": [{ "billed_charge": 96507.09, "npi": [1740262880] } ] } ] } ] }, { "name": "Infectious Agent Antigen Detection", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87626", "description": "the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1089.24, "providers": [{ "billed_charge": 6686.82, "npi": [1740262880] } ] } ] } ] }, { "name": "TRICHOMONAS VAGIN, DIR PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87660", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 845.35, "providers": [{ "billed_charge": 5427.35, "npi": [1740262880] } ] } ] } ] }, { "name": "TRICHOMONAS VAGINALIS AMPLIF", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87661", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7864.63, "providers": [{ "billed_charge": 43696.12, "npi": [1740262880] } ] } ] } ] }, { "name": "DETECT AGENT NOS, DNA, AMP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87798", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1936.25, "providers": [{ "billed_charge": 7027.60, "npi": [1740262880] } ] } ] } ] }, { "name": "DETECT AGNT MULT, DNA, AMPLI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87801", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13555.08, "providers": [{ "billed_charge": 48136.38, "npi": [1740262880] } ] } ] } ] }, { "name": "CYTOPATH C/V AUTO FLUID REDO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88175", "description": "CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1847.30, "providers": [{ "billed_charge": 7604.45, "npi": [1740262880] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88305", "description": "LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4905.17, "providers": [{ "billed_charge": 16755.10, "npi": [1740262880] } ] } ] }, { "tin": { "type": "ein", "value": "860564320" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 559.43, "providers": [{ "billed_charge": 1500.00, "npi": [1205290996] } ] }, { "allowed_amount": 46.62, "providers": [{ "billed_charge": 125.00, "npi": [1205290996] } ] } ] }, { "tin": { "type": "ein", "value": "208893571" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1243.55, "providers": [{ "billed_charge": 4200.00, "npi": [1497956569] } ] } ] } ] }, { "name": "PSYCH DIAG EVAL W/MED SRVCS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90792", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822076807" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4220.73, "providers": [{ "billed_charge": 25000.00, "npi": [1922112572] } ] } ] } ] }, { "name": "PSYTX W PT 30 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90832", "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822076807" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8634.36, "providers": [{ "billed_charge": 109800.00, "npi": [1922112572] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90833", "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462629779" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.12, "providers": [{ "billed_charge": 125.00, "npi": [1669884847] } ] } ] } ] }, { "name": "PSYTX W PT 45 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90834", "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "201020949" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2138.48, "providers": [{ "billed_charge": 5400.00, "npi": [1265841027] } ] }, { "allowed_amount": 156.24, "providers": [{ "billed_charge": 400.00, "npi": [1265841027] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 234.36, "providers": [{ "billed_charge": 600.00, "npi": [1234567893] } ] }, { "allowed_amount": 78.12, "providers": [{ "billed_charge": 200.00, "npi": [1234567893] } ] } ] } ] }, { "name": "PSYTX W PT 60 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90837", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824104161" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 628.43, "providers": [{ "billed_charge": 1050.00, "npi": [1033618103] } ] }, { "allowed_amount": 533.62, "providers": [{ "billed_charge": 875.00, "npi": [1033618103] } ] } ] }, { "tin": { "type": "ein", "value": "833023625" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1851.48, "providers": [{ "billed_charge": 4212.00, "npi": [1376852327] } ] } ] }, { "tin": { "type": "ein", "value": "571203051" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1239.75, "providers": [{ "billed_charge": 1980.00, "npi": [1023726866] } ] }, { "allowed_amount": 3581.50, "providers": [{ "billed_charge": 5720.00, "npi": [1023726866] } ] } ] }, { "tin": { "type": "ein", "value": "825200383" }, "service_code": ["11", "12", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 998.30, "providers": [{ "billed_charge": 1540.00, "npi": [1093362329] } ] }, { "allowed_amount": 849.20, "providers": [{ "billed_charge": 1320.00, "npi": [1093362329] } ] }, { "allowed_amount": 298.20, "providers": [{ "billed_charge": 440.00, "npi": [1093362329] } ] } ] }, { "tin": { "type": "ein", "value": "844582670" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 336.16, "providers": [{ "billed_charge": 2966.00, "npi": [1710207642] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 60 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90838", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "61040288" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4650.00, "providers": [{ "billed_charge": 4650.00, "npi": [1952430647] } ] } ] } ] }, { "name": "SPECIAL EYE EVALUATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92060", "description": "SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR PARETIC ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "753032761" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 62.76, "providers": [{ "billed_charge": 90.00, "npi": [1275912347] } ] } ] } ] }, { "name": "PERI VASCUL LAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "921", "description": "OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471587223" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3744.18, "providers": [{ "billed_charge": 13403.00, "npi": [1154748416] } ] } ] }, { "tin": { "type": "ein", "value": "721561132" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2245.00, "providers": [{ "billed_charge": 11046.00, "npi": [1700910189] } ] } ] }, { "tin": { "type": "ein", "value": "721561134" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3591.92, "providers": [{ "billed_charge": 18852.00, "npi": [1982733655] } ] } ] } ] }, { "name": "EYE PHOTOGRAPHY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92285", "description": "EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PROGRESS (EG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "753032761" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 38.25, "providers": [{ "billed_charge": 45.00, "npi": [1275912347] } ] } ] } ] }, { "name": "SPEECH/HEARING THERAPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92507", "description": "TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "201015104" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 237.12, "providers": [{ "billed_charge": 896.00, "npi": [1780163055] } ] } ] } ] }, { "name": "ELECTROCARDIOGRAM REPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93010", "description": "ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "201291415" }, "service_code": ["11", "22", "19", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.80, "providers": [{ "billed_charge": 258.00, "npi": [1568480093] } ] }, { "allowed_amount": 39.60, "providers": [{ "billed_charge": 66.00, "npi": [1568480093] } ] }, { "allowed_amount": 316.80, "providers": [{ "billed_charge": 528.00, "npi": [1568480093] } ] } ] }, { "tin": { "type": "ein", "value": "860137567" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.04, "providers": [{ "billed_charge": 150.00, "npi": [1851622112] } ] }, { "allowed_amount": 13.04, "providers": [{ "billed_charge": 100.00, "npi": [1851622112] } ] }, { "allowed_amount": 6.52, "providers": [{ "billed_charge": 50.00, "npi": [1851622112] } ] } ] } ] }, { "name": "IMMUNOTHERAPY, ONE INJECTION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95115", "description": "PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "873164803" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 110.24, "providers": [{ "billed_charge": 328.40, "npi": [1407016348] } ] } ] } ] }, { "name": "IMMUNOTHERAPY INJECTIONS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95117", "description": "PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O", "allowed_amounts": [{ "tin": { "type": "ein", "value": "873164803" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 667.12, "providers": [{ "billed_charge": 1896.44, "npi": [1851382550] } ] }, { "allowed_amount": 1540.92, "providers": [{ "billed_charge": 4376.40, "npi": [1407016348] } ] } ] } ] }, { "name": "ANTIGEN THERAPY SERVICES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95165", "description": "PROF SERVICES FOR THE SPRVSN OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHAPY; SING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "873164803" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 597.08, "providers": [{ "billed_charge": 1324.60, "npi": [1851382550] } ] } ] } ] }, { "name": "PT-FOCUSED HLTH RISK ASSMT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96160", "description": "ADMINISTRATION OF PATIENT-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPRAISAL) WI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203134104" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.06, "providers": [{ "billed_charge": 32.90, "npi": [1073578159] } ] }, { "allowed_amount": 14.49, "providers": [{ "billed_charge": 39.48, "npi": [1033166012] } ] }, { "allowed_amount": 4.82, "providers": [{ "billed_charge": 13.16, "npi": [1033166012] } ] }, { "allowed_amount": 12.07, "providers": [{ "billed_charge": 32.90, "npi": [1073578159] } ] } ] } ] }, { "name": "ADAPTIVE BEHAVIOR TX BY TECH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271402749" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2241.90, "providers": [{ "billed_charge": 4700.00, "npi": [1346827805] } ] }, { "allowed_amount": 32269.05, "providers": [{ "billed_charge": 67650.00, "npi": [1427845569] } ] }, { "allowed_amount": 20916.45, "providers": [{ "billed_charge": 43850.00, "npi": [1477446680] } ] }, { "allowed_amount": 24207.75, "providers": [{ "billed_charge": 51450.00, "npi": [1497554901] } ] } ] } ] }, { "name": "Under Established Patient", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98006", "description": "Under Established Patient", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203134104" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2457.76, "providers": [{ "billed_charge": 9594.07, "npi": [1073578159] } ] }, { "allowed_amount": 1502.30, "providers": [{ "billed_charge": 5954.94, "npi": [1033166012] } ] }, { "allowed_amount": 166.36, "providers": [{ "billed_charge": 661.66, "npi": [1336327212] } ] } ] } ] }, { "name": "PRO FEE/ER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "981", "description": "PROFESSIONAL FEES - EMERGENCY ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "721561132" }, "service_code": ["20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1261.50, "providers": [{ "billed_charge": 1682.00, "npi": [1700910189] } ] } ] } ] }, { "name": "REM THER MNTR 1ST SETUP&EDU", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98975", "description": "REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 121.76, "providers": [{ "billed_charge": 137.03, "npi": [1124405915] } ] } ] } ] }, { "name": "Under Remote Therapeutic Monitoring Services", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98978", "description": "Under Remote Therapeutic Monitoring Services", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1239.80, "providers": [{ "billed_charge": 4132.64, "npi": [1124405915] } ] } ] } ] }, { "name": "REM THER MNTR 1ST 20 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98980", "description": "REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2443.00, "providers": [{ "billed_charge": 2713.80, "npi": [1124405915] } ] }, { "allowed_amount": 23.92, "providers": [{ "billed_charge": 40.15, "npi": [1124405915] } ] } ] } ] }, { "name": "REM THER MNTR EA ADDL 20 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98981", "description": "REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2416.26, "providers": [{ "billed_charge": 2776.79, "npi": [1124405915] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99211", "description": "OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237086112" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5811.16, "providers": [{ "billed_charge": 8822.37, "npi": [1477016921] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99213", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812124295" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 913.52, "providers": [{ "billed_charge": 2600.00, "npi": [1932557675] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["02", "17", "20", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.93, "providers": [{ "billed_charge": 276.13, "npi": [1234567893] } ] }, { "allowed_amount": 773.65, "providers": [{ "billed_charge": 1820.00, "npi": [1234567893] } ] }, { "allowed_amount": 800.55, "providers": [{ "billed_charge": 1638.00, "npi": [1234567893] } ] }, { "allowed_amount": 145.00, "providers": [{ "billed_charge": 259.77, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "61040288" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6300.00, "providers": [{ "billed_charge": 6300.00, "npi": [1952430647] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99214", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203134104" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.14, "providers": [{ "billed_charge": 631.40, "npi": [1073578159] } ] }, { "allowed_amount": 1706.56, "providers": [{ "billed_charge": 5051.20, "npi": [1073578159] } ] }, { "allowed_amount": 635.78, "providers": [{ "billed_charge": 1894.20, "npi": [1639243058] } ] } ] }, { "tin": { "type": "ein", "value": "462629779" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 289.86, "providers": [{ "billed_charge": 600.00, "npi": [1669884847] } ] } ] }, { "tin": { "type": "ein", "value": "262566417" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 86.11, "providers": [{ "billed_charge": 150.00, "npi": [1609638311] } ] }, { "allowed_amount": 258.33, "providers": [{ "billed_charge": 450.00, "npi": [1609638311] } ] } ] }, { "tin": { "type": "ein", "value": "873164803" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 552.11, "providers": [{ "billed_charge": 1040.00, "npi": [1407016348] } ] } ] }, { "tin": { "type": "ein", "value": "200589060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 953.66, "providers": [{ "billed_charge": 1600.00, "npi": [1659379378] } ] } ] }, { "tin": { "type": "ein", "value": "823913679" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 313.71, "providers": [{ "billed_charge": 973.44, "npi": [1932467727] } ] } ] }, { "tin": { "type": "ein", "value": "812124295" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1968.40, "providers": [{ "billed_charge": 5000.00, "npi": [1932557675] } ] } ] }, { "tin": { "type": "ein", "value": "454995568" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 112.93, "providers": [{ "billed_charge": 175.00, "npi": [1891971628] } ] }, { "allowed_amount": 4337.53, "providers": [{ "billed_charge": 7175.00, "npi": [1891971628] } ] }, { "allowed_amount": 8884.20, "providers": [{ "billed_charge": 14700.00, "npi": [1891971628] } ] } ] }, { "tin": { "type": "ein", "value": "860692282" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 738.12, "providers": [{ "billed_charge": 900.00, "npi": [1154397750] } ] }, { "allowed_amount": 246.04, "providers": [{ "billed_charge": 300.00, "npi": [1841263662] } ] }, { "allowed_amount": 1230.20, "providers": [{ "billed_charge": 1500.00, "npi": [1285600783] } ] } ] }, { "tin": { "type": "ein", "value": "262236406" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 88.88, "providers": [{ "billed_charge": 206.46, "npi": [1578942165] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99215", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203134104" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 440.37, "providers": [{ "billed_charge": 1336.20, "npi": [1033166012] } ] } ] }, { "tin": { "type": "ein", "value": "823913679" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 733.95, "providers": [{ "billed_charge": 2174.10, "npi": [1932467727] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471036151" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 143.50, "providers": [{ "billed_charge": 190.00, "npi": [1487632659] } ] } ] }, { "tin": { "type": "ein", "value": "452951380" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.68, "providers": [{ "billed_charge": 150.00, "npi": [1013085257] } ] } ] }, { "tin": { "type": "ein", "value": "464156975" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 658.00, "providers": [{ "billed_charge": 940.00, "npi": [1053365213] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "920800921" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.90, "providers": [{ "billed_charge": 340.00, "npi": [1245053008] } ] } ] }, { "tin": { "type": "ein", "value": "363966745" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 650.25, "providers": [{ "billed_charge": 1200.00, "npi": [1700141637] } ] }, { "allowed_amount": 436.34, "providers": [{ "billed_charge": 800.00, "npi": [1679662381] } ] } ] }, { "tin": { "type": "ein", "value": "264691812" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 474.20, "providers": [{ "billed_charge": 1122.90, "npi": [1063446425] } ] } ] }, { "tin": { "type": "ein", "value": "824555574" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3935.96, "providers": [{ "billed_charge": 6560.00, "npi": [1760456032] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99283", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "352574944" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 303.97, "providers": [{ "billed_charge": 7176.00, "npi": [1366563249] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461813341" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 437.76, "providers": [{ "billed_charge": 1273.00, "npi": [1275761900] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99285", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461813341" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5089.06, "providers": [{ "billed_charge": 15192.00, "npi": [1275761900] } ] }, { "allowed_amount": 638.35, "providers": [{ "billed_charge": 1899.00, "npi": [1336728575] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99308", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "473099351" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1129.06, "providers": [{ "billed_charge": 2611.74, "npi": [1689301293] } ] } ] }, { "tin": { "type": "ein", "value": "471098491" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 3578.53, "providers": [{ "billed_charge": 5964.31, "npi": [1467560565] } ] } ] }, { "tin": { "type": "ein", "value": "860831961" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 735.84, "providers": [{ "billed_charge": 1140.92, "npi": [1982637849] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99309", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472188010" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 14774.40, "providers": [{ "billed_charge": 24624.00, "npi": [1740420041] } ] } ] }, { "tin": { "type": "ein", "value": "860975566" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 2913.75, "providers": [{ "billed_charge": 3885.00, "npi": [1992866651] } ] } ] }, { "tin": { "type": "ein", "value": "471554329" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 786.06, "providers": [{ "billed_charge": 1958.00, "npi": [1720688443] } ] } ] }, { "tin": { "type": "ein", "value": "473350388" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 3093.53, "providers": [{ "billed_charge": 6475.00, "npi": [1659771186] } ] } ] }, { "tin": { "type": "ein", "value": "843902969" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1622.72, "providers": [{ "billed_charge": 3245.28, "npi": [1679235808] } ] } ] } ] }, { "name": "PROLNG OFF/OP E/M EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99417", "description": "PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823913679" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 623.70, "providers": [{ "billed_charge": 2413.50, "npi": [1932467727] } ] } ] } ] }, { "name": "1ST PSYC COLLAB CARE MGMT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99492", "description": "INITIAL PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, FIRST 70 MINUTES IN THE FIRST CALENDAR MONTH OF B", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3139.83, "providers": [{ "billed_charge": 3434.93, "npi": [1124405915] } ] } ] } ] }, { "name": "SBSQ PSYC COLLAB CARE MGMT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99493", "description": "SUBSEQUENT PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, FIRST 60 MINUTES IN A SUBSEQUENT MONTH OF BEHA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8737.10, "providers": [{ "billed_charge": 9710.96, "npi": [1124405915] } ] } ] } ] }, { "name": "1ST/SBSQ PSYC COLLAB CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99494", "description": "INITIAL OR SUBSEQUENT PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, EACH ADDITIONAL 30 MINUTES IN A CAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923862746" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18546.02, "providers": [{ "billed_charge": 20467.12, "npi": [1124405915] } ] } ] } ] }, { "name": "BLS ROUTINE DISPOSABLE SUPPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0382", "description": "BLS ROUTINE DISPOSABLE SUPPLIES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 594.65, "providers": [{ "billed_charge": 594.65, "npi": [1851781314] } ] } ] } ] }, { "name": "ALS ROUTNE DISPSABLE SUPPLS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0398", "description": "ALS ROUTINE DISPOSABLE SUPPLIES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 642.79, "providers": [{ "billed_charge": 642.79, "npi": [1851781314] } ] } ] } ] }, { "name": "GRND MLGE PER STATUTE MILE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE, PER STATUTE MILE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860110232" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 988.26, "providers": [{ "billed_charge": 1040.28, "npi": [1518143205] } ] } ] }, { "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 15772.47, "providers": [{ "billed_charge": 17555.59, "npi": [1851781314] } ] } ] } ] }, { "name": "AMB SVC ALS NON ER TRSPRT L1", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0426", "description": "AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2525.76, "providers": [{ "billed_charge": 3608.22, "npi": [1851781314] } ] } ] } ] }, { "name": "AMB SVC ALS ER TRNSPRT LVL1", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860110232" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3310.06, "providers": [{ "billed_charge": 3484.28, "npi": [1518143205] } ] } ] }, { "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2405.48, "providers": [{ "billed_charge": 2405.48, "npi": [1851781314] } ] } ] } ] }, { "name": "AMB SERVICE BLS NONEMERG TRA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0428", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 60853.82, "providers": [{ "billed_charge": 61068.09, "npi": [1851781314] } ] } ] } ] }, { "name": "AMB SERVICE BLS EMERGENCY TR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300824958" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1071.37, "providers": [{ "billed_charge": 1071.37, "npi": [1851781314] } ] } ] } ] }, { "name": "PROSTATE CANCER SCREENING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0103", "description": "PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3409.78, "providers": [{ "billed_charge": 28525.50, "npi": [1740262880] } ] } ] } ] }, { "name": "SCR CERV/VAG THIN LAY W/PHYS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0123", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 543.55, "providers": [{ "billed_charge": 2389.15, "npi": [1740262880] } ] } ] } ] }, { "name": "SCR CERV/VAG THIN LAY PHYS I", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0124", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 709.92, "providers": [{ "billed_charge": 3710.05, "npi": [1740262880] } ] } ] } ] }, { "name": "SCR CERV/VAG AUTO&MNL RSCR P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0145", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17518.51, "providers": [{ "billed_charge": 81191.08, "npi": [1740262880] } ] } ] } ] }, { "name": "DX DIGTL BRST TOMOSYN UNI/BI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0279", "description": "DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 770", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200382536" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 336.00, "providers": [{ "billed_charge": 1952.00, "npi": [1154558039] } ] } ] } ] }, { "name": "COLOREC CA SCR; FOB TST IMMU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0328", "description": "COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS DETERMINATIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 253.00, "providers": [{ "billed_charge": 2479.00, "npi": [1740262880] } ] } ] } ] }, { "name": "HEP C ABO SC IND HI RSK&OTH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0472", "description": "HEPATITIS C ANTIBODY SCREENING FOR INDIVIDUAL AT HIGH RISK AND OTHER COVERED INDICATION(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 768.80, "providers": [{ "billed_charge": 4072.75, "npi": [1740262880] } ] } ] } ] }, { "name": "HIV ANTIGEN/ANTIBODY, COMBIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0475", "description": "HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 842.40, "providers": [{ "billed_charge": 8377.77, "npi": [1740262880] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 1-7", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0480", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "201236503" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3533.38, "providers": [{ "billed_charge": 10641.99, "npi": [1225110497] } ] } ] } ] }, { "name": "MED ASST TX METHADONE;WEEKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2067", "description": "MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "201264723" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 307.48, "providers": [{ "billed_charge": 1229.96, "npi": [1942704671] } ] } ] } ] }, { "name": "MAT BUPRENORPHINE ORAL; WKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2068", "description": "MED ASST TX BUPRENORPHINE ORAL; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "201264723" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 627.34, "providers": [{ "billed_charge": 2509.29, "npi": [1942704671] } ] } ] } ] }, { "name": "BEHAVIORAL HEALTH CNSL&TX-15", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0004", "description": "BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460624198" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 766.07, "providers": [{ "billed_charge": 1150.00, "npi": [1689438921] } ] }, { "allowed_amount": 799.38, "providers": [{ "billed_charge": 1200.00, "npi": [1780497677, 1245110683] } ] }, { "allowed_amount": 1598.76, "providers": [{ "billed_charge": 2400.00, "npi": [1205638368] } ] }, { "allowed_amount": 266.46, "providers": [{ "billed_charge": 400.00, "npi": [1780497677] } ] }, { "allowed_amount": 133.23, "providers": [{ "billed_charge": 200.00, "npi": [1245110683] } ] }, { "allowed_amount": 2231.60, "providers": [{ "billed_charge": 3350.00, "npi": [1205638368] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC;METHDONE ADM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0020", "description": "ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860606635" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.62, "providers": [{ "billed_charge": 176.80, "npi": [1043462526] } ] } ] } ] }, { "name": "ORAL MEDADMIN DIR OBSERV", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0033", "description": "ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237086112" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2232.58, "providers": [{ "billed_charge": 8930.47, "npi": [1477016921] } ] } ] } ] }, { "name": "COMP MDICTION SVC PER 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H2010", "description": "COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860606635" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.25, "providers": [{ "billed_charge": 15.64, "npi": [1821431560] } ] }, { "allowed_amount": 676.65, "providers": [{ "billed_charge": 1016.60, "npi": [1043462526] } ] } ] } ] }, { "name": "BPN/NLX O >6 MG BUT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0574", "description": "BUPRENORPHINE/NALOXONE, ORAL, GREATER THAN 6 MG, BUT LESS THAN OR EQUAL TO 10 MG BUPRENORPHINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860606635" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 129.40, "providers": [{ "billed_charge": 517.66, "npi": [1043462526] } ] } ] } ] }, { "name": "BPN/NALOXONE ORAL >10 MG BPN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0575", "description": "BUPRENORPHINE/NALOXONE, ORAL, GREATER THAN 10 MG BUPRENORPHINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860606635" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 61.20, "providers": [{ "billed_charge": 244.80, "npi": [1043462526] } ] } ] } ] }, { "name": "NONEMERG TRANSP MLG PER MILE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S0215", "description": "NONEMERGENCY TRANSPORTATION; MILEAGE, PER MILE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942880847" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 478.80, "providers": [{ "billed_charge": 1915.20, "npi": [1891288049] } ] } ] } ] }, { "name": "CRISIS INTRVNT MNTL HLTH SVC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9485", "description": "CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "364872543" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 6469.32, "providers": [{ "billed_charge": 25877.04, "npi": [1982362943] } ] } ] }, { "tin": { "type": "ein", "value": "942880847" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5250.00, "providers": [{ "billed_charge": 21000.00, "npi": [1285127043] } ] }, { "allowed_amount": 58500.00, "providers": [{ "billed_charge": 234000.00, "npi": [1891288049] } ] } ] } ] } ] }