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[{ "billed_charge": 2131.92, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 279.22, "providers": [{ "billed_charge": 1105.84, "npi": [1234567893] } ] } ] } ] }, { "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": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 237.60, "providers": [{ "billed_charge": 950.40, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 71.90, "providers": [{ "billed_charge": 316.80, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4483.84, "providers": [{ "billed_charge": 52834.52, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1056.00, "providers": [{ "billed_charge": 4200.00, "npi": [1225021678] } ] } ] } ] }, { "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": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 174.20, "providers": [{ "billed_charge": 1460.16, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.88, "providers": [{ "billed_charge": 321.36, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5183.34, "providers": [{ "billed_charge": 59930.31, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 669.50, "providers": [{ "billed_charge": 2900.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ACUTE HEPATITIS PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80074", "description": "ACUTE 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OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883706617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 290.51, "providers": [{ "billed_charge": 1100.00, "npi": [1427398007] } ] } ] }, { "tin": { "type": "ein", "value": "821447166" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 888.93, "providers": [{ "billed_charge": 1491.36, "npi": [1336956564] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18287.33, "providers": [{ "billed_charge": 155072.91, "npi": [1234567893] } ] } ] } ] }, { "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": "822647012" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 61.37, "providers": [{ "billed_charge": 190.00, "npi": [1649001058] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.13, "providers": [{ "billed_charge": 1228.60, "npi": [1234567893] } ] } ] } ] }, { "name": "URINALYSIS NONAUTO W/O SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81002", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581131002" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.18, "providers": [{ "billed_charge": 126.00, "npi": [1144041062] } ] } ] }, { "tin": { "type": "ein", "value": "800058224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 100.65, "providers": [{ "billed_charge": 734.00, "npi": [1861486094] } ] } ] }, { "tin": { "type": "ein", "value": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.70, "providers": [{ "billed_charge": 407.00, "npi": [1124064316] } ] }, { "allowed_amount": 19.38, "providers": [{ "billed_charge": 111.00, "npi": [1932131281] } ] } ] }, { "tin": { "type": "ein", "value": "581187683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.30, "providers": [{ "billed_charge": 32.00, "npi": [1568481539] } ] } ] }, { "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.58, "providers": [{ "billed_charge": 510.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "205870972" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.16, "providers": [{ "billed_charge": 680.00, "npi": [1285325282] } ] } ] }, { "tin": { "type": "ein", "value": "453766969" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.96, "providers": [{ "billed_charge": 620.08, "npi": [1053536177] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 266.68, "providers": [{ "billed_charge": 826.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "852204789" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 412.53, "providers": [{ "billed_charge": 1530.00, "npi": [1073612115] } ] }, { "allowed_amount": 140.40, "providers": [{ "billed_charge": 517.50, "npi": [1194953638] } ] }, { "allowed_amount": 110.93, "providers": [{ "billed_charge": 405.00, "npi": [1295806495] } ] }, { "allowed_amount": 88.68, "providers": [{ "billed_charge": 315.00, "npi": [1164166922] } ] } ] }, { "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.30, "providers": [{ "billed_charge": 168.00, "npi": [1093391997] } ] } ] }, { "tin": { "type": "ein", "value": "465736753" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.48, "providers": [{ "billed_charge": 15.00, "npi": [1144887472] } ] } ] }, { "tin": { "type": "ein", "value": "582610763" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.22, "providers": [{ "billed_charge": 30.00, "npi": [1306860044] } ] } ] } ] }, { "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": "581109444" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.86, "providers": [{ "billed_charge": 154.00, "npi": [1699112953] } ] }, { "allowed_amount": 17.08, "providers": [{ "billed_charge": 110.00, "npi": [1700632338] } ] } ] }, { "tin": { "type": "ein", "value": "582618143" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.08, "providers": [{ "billed_charge": 156.00, "npi": [1154397677] } ] } ] }, { "tin": { "type": "ein", "value": "990909070" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.40, "providers": [{ "billed_charge": 48.00, "npi": [1285971796] } ] }, { "allowed_amount": 4.60, "providers": [{ "billed_charge": 12.00, "npi": [1538557061] } ] }, { "allowed_amount": 9.20, "providers": [{ "billed_charge": 24.00, "npi": [1861125312] } ] } ] }, { "tin": { "type": "ein", "value": "992262156" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.73, "providers": [{ "billed_charge": 189.00, "npi": [1457400251] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.43, "providers": [{ "billed_charge": 27.00, "npi": [1295969228] } ] } ] }, { "tin": { "type": "ein", "value": "271738064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.40, "providers": [{ "billed_charge": 144.00, "npi": [1851750582] } ] } ] } ] }, { "name": "MICROSCOPIC EXAM OF URINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81015", "description": "URINALYSIS; MICROSCOPIC ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.01, "providers": [{ "billed_charge": 252.00, "npi": [1912167578] } ] } ] } ] }, { "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": "586000373" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.93, "providers": [{ "billed_charge": 30.00, "npi": [1093789075] } ] } ] }, { "tin": { "type": "ein", "value": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 48.44, "providers": [{ "billed_charge": 75.00, "npi": [1932131281] } ] } ] }, { "tin": { "type": "ein", "value": "582618143" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 112.87, "providers": [{ "billed_charge": 175.00, "npi": [1154397677] } ] } ] }, { "tin": { "type": "ein", "value": "852204789" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.99, "providers": [{ "billed_charge": 25.00, "npi": [1194953638] } ] }, { "allowed_amount": 527.97, "providers": [{ "billed_charge": 875.00, "npi": [1073612115] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 372.19, "providers": [{ "billed_charge": 4417.37, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.69, "providers": [{ "billed_charge": 72.00, "npi": [1912167578] } ] }, { "allowed_amount": 36.15, "providers": [{ "billed_charge": 120.00, "npi": [1295969228] } ] } ] } ] }, { "name": "HEMO/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844408280" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2706.00, "providers": [{ "billed_charge": 26496.00, "npi": [1023774429] } ] }, { "allowed_amount": 2701.55, "providers": [{ "billed_charge": 64927.32, "npi": [1023774429] } ] } ] }, { "tin": { "type": "ein", "value": "261305281" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5237.07, "providers": [{ "billed_charge": 87695.69, "npi": [1235317454] } ] } ] }, { "tin": { "type": "ein", "value": "463731566" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19000.00, "providers": [{ "billed_charge": 167808.00, "npi": [1760899710] } ] } ] }, { "tin": { "type": "ein", "value": "300996078" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16067.04, "providers": [{ "billed_charge": 382643.83, "npi": [1093237836] } ] } ] }, { "tin": { "type": "ein", "value": "582350026" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 103000.00, "providers": [{ "billed_charge": 909696.00, "npi": [1003928821] } ] }, { "allowed_amount": 12000.00, "providers": [{ "billed_charge": 105984.00, "npi": [1003928821] } ] } ] }, { "tin": { "type": "ein", "value": "953372911" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1641.06, "providers": [{ "billed_charge": 35820.00, "npi": [1861825515] } ] } ] }, { "tin": { "type": "ein", "value": "952977916" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13951.42, "providers": [{ "billed_charge": 77610.00, "npi": [1356302921] } ] } ] }, { "tin": { "type": "ein", "value": "994035406" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7481.78, "providers": [{ "billed_charge": 238464.00, "npi": [1346060043] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.96, "providers": [{ "billed_charge": 441.76, "npi": [1234567893] } ] } ] } ] }, { "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": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 296.00, "providers": [{ "billed_charge": 2481.60, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4221.98, "providers": [{ "billed_charge": 45356.50, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 141.05, "providers": [{ "billed_charge": 621.60, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1835.20, "providers": [{ "billed_charge": 9300.00, "npi": [1225021678] } ] } ] } ] }, { "name": "TOTAL CORTISOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82533", "description": "CORTISOL; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.76, "providers": [{ "billed_charge": 260.80, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 338.69, "providers": [{ "billed_charge": 3946.80, "npi": [1234567893] } ] } ] } ] }, { "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": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.86, "providers": [{ "billed_charge": 568.62, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.30, "providers": [{ "billed_charge": 226.20, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1786.40, "providers": [{ "billed_charge": 18774.18, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 754.00, "providers": [{ "billed_charge": 3500.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 107.54, "providers": [{ "billed_charge": 789.19, "npi": [1234567893] } ] } ] } ] }, { "name": "PANCREATIC ELASTASE, FECAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82656", "description": "ELASTASE, PANCREATIC (EL-1), FECAL, QUALITATIVE OR SEMI-QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853877508" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.31, "providers": [{ "billed_charge": 65.73, "npi": [1497423198] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1693.85, "providers": [{ "billed_charge": 18281.62, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 621.94, "providers": [{ "billed_charge": 7135.16, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 190.82, "providers": [{ "billed_charge": 952.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 612.42, "providers": [{ "billed_charge": 6875.55, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 117.60, "providers": [{ "billed_charge": 512.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID, RBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82747", "description": "FOLIC ACID; RBC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.80, "providers": [{ "billed_charge": 141.20, "npi": [1234567893] } ] } ] } ] }, { "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": "582610763" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.76, "providers": [{ "billed_charge": 160.00, "npi": [1306860044] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 44.49, "providers": [{ "billed_charge": 498.67, "npi": [1234567893] } ] } ] } ] }, { "name": "GLUCOSE BLOOD TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82962", "description": "GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800058224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 49.88, "providers": [{ "billed_charge": 580.00, "npi": [1861486094] } ] } ] }, { "tin": { "type": "ein", "value": "582545719" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 101.99, "providers": [{ "billed_charge": 345.00, "npi": [1063515815] } ] } ] }, { "tin": { "type": "ein", "value": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 94.90, "providers": [{ "billed_charge": 630.00, "npi": [1124064316] } ] } ] }, { "tin": { "type": "ein", "value": "852204789" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 181.75, "providers": [{ "billed_charge": 382.72, "npi": [1073612115] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.90, "providers": [{ "billed_charge": 90.00, "npi": [1790281723] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.20, "providers": [{ "billed_charge": 518.40, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 755.36, "providers": [{ "billed_charge": 7775.54, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 373.49, "providers": [{ "billed_charge": 4254.84, "npi": [1234567893] } ] } ] } ] }, { "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": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 345.82, "providers": [{ "billed_charge": 2300.00, "npi": [1124064316] } ] } ] }, { "tin": { "type": "ein", "value": "581394645" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.52, "providers": [{ "billed_charge": 88.00, "npi": [1497486047] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 555.28, "providers": [{ "billed_charge": 1584.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.08, "providers": [{ "billed_charge": 1139.04, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "331166863" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.40, "providers": [{ "billed_charge": 640.00, "npi": [1790707925] } ] } ] }, { "tin": { "type": "ein", "value": "852204789" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.39, "providers": [{ "billed_charge": 288.53, "npi": [1073612115] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.89, "providers": [{ "billed_charge": 90.00, "npi": [1234567893] } ] }, { "allowed_amount": 2034.53, "providers": [{ "billed_charge": 22679.94, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.05, "providers": [{ "billed_charge": 145.65, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 145.68, "providers": [{ "billed_charge": 480.00, "npi": [1790281723] } ] } ] }, { "tin": { "type": "ein", "value": "581719867" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.66, "providers": [{ "billed_charge": 160.00, "npi": [1669728697] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 699.12, "providers": [{ "billed_charge": 3312.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.66, "providers": [{ "billed_charge": 1677.32, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 341.37, "providers": [{ "billed_charge": 3922.48, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.82, "providers": [{ "billed_charge": 38.82, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 155.28, "providers": [{ "billed_charge": 768.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 343.66, "providers": [{ "billed_charge": 4068.40, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.76, "providers": [{ "billed_charge": 840.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY LIPOPROTEIN PLA2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83698", "description": "LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.94, "providers": [{ "billed_charge": 370.48, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.33, "providers": [{ "billed_charge": 2174.15, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.33, "providers": [{ "billed_charge": 471.12, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY FOR CALPROTECTIN FECAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83993", "description": "CALPROTECTIN, FECAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853877508" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 127.66, "providers": [{ "billed_charge": 484.90, "npi": [1497423198] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.19, "providers": [{ "billed_charge": 62.16, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.16, "providers": [{ "billed_charge": 37.92, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 416.86, "providers": [{ "billed_charge": 3905.92, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 273.99, "providers": [{ "billed_charge": 3231.52, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1146.85, "providers": [{ "billed_charge": 13538.79, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.78, "providers": [{ "billed_charge": 230.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 343.84, "providers": [{ "billed_charge": 4119.36, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.99, "providers": [{ "billed_charge": 64.24, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 578.88, "providers": [{ "billed_charge": 6697.61, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 748.88, "providers": [{ "billed_charge": 8965.44, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1827.74, "providers": [{ "billed_charge": 19210.41, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 167.18, "providers": [{ "billed_charge": 1944.22, "npi": [1234567893] } ] } ] } ] }, { "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": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.28, "providers": [{ "billed_charge": 54.12, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1156.87, "providers": [{ "billed_charge": 13681.03, "npi": [1234567893] } ] } ] } ] }, { "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": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.00, "providers": [{ "billed_charge": 2112.30, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.08, "providers": [{ "billed_charge": 352.80, "npi": [1174092548] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5080.20, "providers": [{ "billed_charge": 59985.68, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1159.20, "providers": [{ "billed_charge": 4968.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.19, "providers": [{ "billed_charge": 62.16, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.31, "providers": [{ "billed_charge": 63.60, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.44, "providers": [{ "billed_charge": 312.62, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.32, "providers": [{ "billed_charge": 51.76, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 151.68, "providers": [{ "billed_charge": 1815.04, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 347.99, "providers": [{ "billed_charge": 3786.09, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 146.47, "providers": [{ "billed_charge": 1753.76, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 162.72, "providers": [{ "billed_charge": 576.00, "npi": [1225021678] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 342.23, "providers": [{ "billed_charge": 3976.70, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.32, "providers": [{ "billed_charge": 75.84, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.96, "providers": [{ "billed_charge": 91.33, "npi": [1174092548] } ] } ] } ] }, { "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": "822647012" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.42, "providers": [{ "billed_charge": 10.00, "npi": [1649001058] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.32, "providers": [{ "billed_charge": 75.84, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.96, "providers": [{ "billed_charge": 93.20, "npi": [1174092548] } ] } ] } ] }, { "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": "921353241" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.20, "providers": [{ "billed_charge": 23.00, "npi": [1811286446] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 290.58, "providers": [{ "billed_charge": 868.00, "npi": [1861473472] } ] } ] }, { "tin": { "type": "ein", "value": "824681345" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.08, "providers": [{ "billed_charge": 116.00, "npi": [1649831314] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 171.15, "providers": [{ "billed_charge": 666.44, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 333.30, "providers": [{ "billed_charge": 1056.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3275.87, "providers": [{ "billed_charge": 38454.62, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.68, "providers": [{ "billed_charge": 256.00, "npi": [1073254363] } ] }, { "allowed_amount": 213.62, "providers": [{ "billed_charge": 704.00, "npi": [1912167578] } ] } ] }, { "tin": { "type": "ein", "value": "271738064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.82, "providers": [{ "billed_charge": 252.00, "npi": [1851750582] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 738.15, "providers": [{ "billed_charge": 3800.00, "npi": [1225021678] } ] } ] } ] }, { "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": "591228604" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.60, "providers": [{ "billed_charge": 99.00, "npi": [1619060787] } ] }, { "allowed_amount": 10.80, "providers": [{ "billed_charge": 27.00, "npi": [1619060787] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.61, "providers": [{ "billed_charge": 271.32, "npi": [1234567893] } ] } ] } ] }, { "name": "CCPD/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "851", "description": "CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "232798598" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5910.74, "providers": [{ "billed_charge": 40381.00, "npi": [1447214812] } ] } ] } ] }, { "name": "RBC SED RATE, NONAUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85651", "description": "SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 76.50, "providers": [{ "billed_charge": 894.57, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 145.44, "providers": [{ "billed_charge": 1740.96, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 62.27, "providers": [{ "billed_charge": 719.53, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 165.24, "providers": [{ "billed_charge": 1978.56, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.91, "providers": [{ "billed_charge": 573.76, "npi": [1234567893] } ] } ] } ] }, { "name": "T CELL, ABSOLUTE COUNT/RATIO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86360", "description": "T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.69, "providers": [{ "billed_charge": 187.92, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.02, "providers": [{ "billed_charge": 822.09, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.48, "providers": [{ "billed_charge": 521.64, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 538.20, "providers": [{ "billed_charge": 10400.00, "npi": [1234567893] } ] } ] } ] }, { "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": "382084239" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.12, "providers": [{ "billed_charge": 87.48, "npi": [1518903350] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.55, "providers": [{ "billed_charge": 58.75, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.10, "providers": [{ "billed_charge": 4489.00, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 159.60, "providers": [{ "billed_charge": 1854.99, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 354.31, "providers": [{ "billed_charge": 4132.13, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 234.56, "providers": [{ "billed_charge": 2780.50, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 174.80, "providers": [{ "billed_charge": 2035.16, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 161.46, "providers": [{ "billed_charge": 1932.84, "npi": [1234567893] } ] } ] } ] }, { "name": "RUBELLA ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", 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"ein", "value": "581896468" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 406.00, "providers": [{ "billed_charge": 580.00, "npi": [1598949547] } ] }, { "allowed_amount": 28.00, "providers": [{ "billed_charge": 40.00, "npi": [1386602662] } ] } ] }, { "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 497.64, "providers": [{ "billed_charge": 1034.00, "npi": [1093391997] } ] } ] }, { "tin": { "type": "ein", "value": "581974299" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1117.84, "providers": [{ "billed_charge": 1345.00, "npi": [1215472360] } ] } ] }, { "tin": { "type": "ein", "value": "453072990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 686.55, "providers": [{ "billed_charge": 1714.00, "npi": [1649910712] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC; INTENSV 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263.67, "providers": [{ "billed_charge": 1154.97, "npi": [1508521790] } ] } ] } ] }, { "name": "MENTAL HLTH PART HOSP TX <24", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0035", "description": "MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "992174368" }, "service_code": ["57"], "billing_class": "professional", "payments": [{ "allowed_amount": 12375.00, "providers": [{ "billed_charge": 75000.00, "npi": [1083976971] } ] } ] } ] }, { "name": "COMP CMTY SUPPRT SRV PER 15", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H2015", "description": "COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200690840" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 1939.20, "providers": [{ "billed_charge": 2680.20, "npi": [1174891774] } ] } ] 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"providers": [{ "billed_charge": 50.00, "npi": [1295806495] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.92, "providers": [{ "billed_charge": 40.00, "npi": [1225021678] } ] } ] } ] }, { "name": "Injection, methylprednisolone acetate, 1 mg ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1010", "description": "Injection, methylprednisolone acetate, 1 mg ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.08, "providers": [{ "billed_charge": 315.00, "npi": [1225021678] } ] } ] } ] }, { "name": "INJ DEXMETH SODM PHOSHA 1MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1100", "description": "INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": 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"npi": [1538132857] } ] }, { "allowed_amount": 47.29, "providers": [{ "billed_charge": 7950.00, "npi": [1144887472] } ] }, { "allowed_amount": 2.39, "providers": [{ "billed_charge": 465.00, "npi": [1255381950] } ] }, { "allowed_amount": 0.77, "providers": [{ "billed_charge": 150.00, "npi": [1346064177] } ] }, { "allowed_amount": 17.60, "providers": [{ "billed_charge": 3165.00, "npi": [1750179412] } ] }, { "allowed_amount": 21.90, "providers": [{ "billed_charge": 3825.00, "npi": [1053860361] } ] } ] } ] }, { "name": "INJ KETOROLAC TROMETHAMINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1885", "description": "INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 0.60, "providers": [{ "billed_charge": 280.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "852204789" }, 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"providers": [{ "billed_charge": 18564.00, "npi": [1234567893] } ] } ] } ] }, { "name": "TRAVL 1 WAY NEC LAB SPEC; AC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "P9603", "description": "TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582328865" }, "service_code": ["31", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 2684.40, "providers": [{ "billed_charge": 6711.01, "npi": [1760579825] } ] }, { "allowed_amount": 47.32, "providers": [{ "billed_charge": 118.32, "npi": [1760579825] } ] } ] } ] }, { "name": "VERT AXIAL DECOMPRS PER SESS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9090", "description": "VERTEBRAL AXIAL DECOMPRESSION, PER SESSION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582068734" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1380.00, "providers": [{ "billed_charge": 4600.00, "npi": [1174005284] } ] } ] } ] }, { "name": "HOM HLTH AIDE/CNA PROV CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9122", "description": "HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PROVIDING CARE IN THE HOME; PER HOUR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "454051201" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4385.50, "providers": [{ "billed_charge": 5021.00, "npi": [1760754113] } ] } ] } ] }, { "name": "NRS CARE HOM; REGISTERED NUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9123", "description": "NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NOT TO ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "454051201" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 630.00, "providers": [{ "billed_charge": 630.00, "npi": [1760754113] } ] } ] } ] }, { "name": "HIT IMPLANTED PUMP PAIN MGMT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9328", "description": "HOME INFUSION THERAPY, IMPLANTED PUMP PAIN MANAGEMENT INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2160.00, "providers": [{ "billed_charge": 7200.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HOME INFUS TX IMMUOTHAPY; PE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9338", "description": "HOME INFUSION THERAPY, IMMUNOTHERAPY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "20651651" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.00, "providers": [{ "billed_charge": 400.00, "npi": [1982602991] } ] } ] } ] }, { "name": "LACTATION CLASS NON-PHYS PRO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9443", "description": "LACTATION CLASSES, NONPHYSICIAN PROVIDER, PER SESSION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "850867370" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1932.00, "providers": [{ "billed_charge": 5100.00, "npi": [1699369124] } ] } ] } ] }, { "name": "NURSING ASSESSMENT/EVALUATIO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "T1001", "description": "NURSING ASSESSMENT/EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582109188" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 3993.75, "providers": [{ "billed_charge": 15975.00, "npi": [1669456620] } ] } ] } ] } ] }