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}, { "tin": { "type": "ein", "value": "830565295" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 509.82, "providers": [{ "billed_charge": 77.06, "npi": [1972080752] } ] }, { "allowed_amount": 107.85, "providers": [{ "billed_charge": 59.28, "npi": [1972080752] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.25, "providers": [{ "billed_charge": 139.94, "npi": [1568431088] } ] }, { "allowed_amount": 57.20, "providers": [{ "billed_charge": 139.94, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 774.15, "providers": [{ "billed_charge": 508.79, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1920.37, "providers": [{ "billed_charge": 1145.76, "npi": [1861018574] } ] }, { "allowed_amount": 48772.06, "providers": [{ "billed_charge": 13749.12, "npi": [1720279805] } ] }, { "allowed_amount": 1496.24, "providers": [{ "billed_charge": 443.52, "npi": [1578549044] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2826.85, "providers": [{ "billed_charge": 754.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1081.12, "providers": [{ "billed_charge": 434.70, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 780.05, "providers": [{ "billed_charge": 882.69, "npi": [1043256886] } ] } ] } ] }, { "name": "LIPID PANEL", 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"billed_charge": 239.20, "npi": [1730119553] } ] }, { "allowed_amount": 1491.76, "providers": [{ "billed_charge": 613.76, "npi": [1730119553] } ] }, { "allowed_amount": 1711.94, "providers": [{ "billed_charge": 972.56, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1945.40, "providers": [{ "billed_charge": 420.00, "npi": [1174113534] } ] }, { "allowed_amount": 486.40, "providers": [{ "billed_charge": 70.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 744.15, "providers": [{ "billed_charge": 461.00, "npi": [1730466590] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 36047.33, "providers": [{ "billed_charge": 38477.52, "npi": [1508499393] } ] } ] }, { "tin": { "type": "ein", "value": "452215107" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4411.94, "providers": [{ "billed_charge": 5033.34, "npi": [1801226543] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 59269.95, "providers": [{ "billed_charge": 326297.07, "npi": [1063011898] } ] } ] }, { "tin": { "type": "ein", "value": "920971049" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 807.82, "providers": [{ "billed_charge": 4500.00, "npi": [1952189086] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 519.24, "providers": [{ "billed_charge": 57.16, "npi": [1730119553] } ] }, { "allowed_amount": 1929.44, "providers": [{ "billed_charge": 134.16, "npi": [1730119553] } ] }, { "allowed_amount": 3074.06, "providers": [{ "billed_charge": 106.38, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.20, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] }, { "allowed_amount": 733.80, "providers": [{ "billed_charge": 210.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31200.78, "providers": [{ "billed_charge": 2374.56, "npi": [1720279805] } ] }, { "allowed_amount": 100.28, "providers": [{ "billed_charge": 12.24, "npi": [1861018574] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 478.99, "providers": [{ "billed_charge": 39.00, "npi": [1316984388] } ] }, { "allowed_amount": 220.42, "providers": [{ "billed_charge": 33.00, "npi": [1316984388] } ] }, { "allowed_amount": 1458.58, "providers": [{ "billed_charge": 156.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.70, "providers": [{ "billed_charge": 24.33, "npi": [1356409379] } ] }, { "allowed_amount": 2424.08, "providers": [{ "billed_charge": 190.90, "npi": [1356409379] } ] }, { "allowed_amount": 413.67, "providers": [{ "billed_charge": 170.31, "npi": [1356409379] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "HCPCS", "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": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5067.36, "providers": [{ "billed_charge": 195.80, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 495.06, "providers": [{ "billed_charge": 101.04, "npi": [1356409379] } ] } ] } ] }, { "name": "FETAL CHRMOML ANEUPLOIDY", "billing_code_type": "HCPCS", "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": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17557.69, "providers": [{ "billed_charge": 24289.60, "npi": [1598314437] } ] } ] } ] }, { "name": "FETAL CHRMOML MICRODELTJ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81422", "description": "FETAL CHROMOSOMAL MICRODELETION(S) GENOMIC SEQUENCE ANALYSIS (EG, DIGEORGE SYNDROME, CRI-DU-CHAT SYN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10605.50, "providers": [{ "billed_charge": 18217.20, "npi": [1598314437] } ] } ] } ] }, { "name": "UNLISTED MOLECULAR PATHOLOGY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81479", "description": "UNLISTED MOLECULAR PATHOLOGY PROCEDURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "465193717" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 41203.12, "providers": [{ "billed_charge": 1612.74, "npi": [1467850859] } ] } ] } ] }, { "name": "NFCT DS BV RNA VAG FLU ALG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81513", "description": "NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40654.39, "providers": [{ "billed_charge": 41434.43, "npi": [1720279805] } ] } ] } ] }, { "name": "MICROALBUMIN, QUANTITATIVE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82043", "description": "ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14615.98, "providers": [{ "billed_charge": 2811.90, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF APOLIPOPROTEIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82172", "description": "APOLIPOPROTEIN, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9146.05, "providers": [{ "billed_charge": 2878.98, "npi": [1720279805] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3189.70, "providers": [{ "billed_charge": 158.13, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY TEST FOR BLOOD, FECAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82274", "description": "BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 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"billing_class": "professional", "payments": [{ "allowed_amount": 201.25, "providers": [{ "billed_charge": 553.32, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.21, "providers": [{ "billed_charge": 275.00, "npi": [1548225428] } ] } ] } ] }, { "name": "ASSAY OF CK (CPK)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82550", "description": "CREATINE KINASE (CK), (CPK); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 412.22, "providers": [{ "billed_charge": 68.37, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15239.07, "providers": [{ "billed_charge": 1758.61, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22231.92, "providers": [{ "billed_charge": 4539.08, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.96, "providers": [{ "billed_charge": 82.50, "npi": [1548225428] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7429.48, "providers": [{ "billed_charge": 3383.26, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 39119.24, "providers": [{ "billed_charge": 8683.22, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7539.15, "providers": [{ "billed_charge": 1389.15, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3538.54, "providers": [{ "billed_charge": 1114.70, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.49, "providers": [{ "billed_charge": 29.95, "npi": [1356409379] } ] }, { "allowed_amount": 11737.16, "providers": [{ "billed_charge": 3670.75, "npi": [1356409379] } ] } ] } ] }, { "name": "REAGENT STRIP/BLOOD GLUCOSE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82948", "description": "GLUCOSE; BLOOD, REAGENT STRIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.00, "providers": [{ "billed_charge": 52.47, "npi": [1730119553] } ] }, { "allowed_amount": 10599.49, "providers": [{ "billed_charge": 594.66, "npi": [1730119553] } ] } ] } ] }, { "name": "GLUCOSE BLOOD TEST", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3634.02, "providers": [{ "billed_charge": 2581.84, "npi": [1730119553] } ] }, { "allowed_amount": 5.42, "providers": [{ "billed_charge": 64.28, "npi": [1730119553] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5923.13, "providers": [{ "billed_charge": 1495.69, "npi": [1720279805] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4153.04, "providers": [{ "billed_charge": 2219.59, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 956.37, "providers": [{ "billed_charge": 244.00, "npi": [1316984388] } ] }, { "allowed_amount": 209.92, "providers": [{ "billed_charge": 34.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1055.34, "providers": [{ "billed_charge": 607.40, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 120921.35, "providers": [{ "billed_charge": 19306.32, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1496.74, "providers": [{ "billed_charge": 554.40, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3775.17, "providers": [{ "billed_charge": 1826.45, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 956.54, "providers": [{ "billed_charge": 518.20, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 216.45, "providers": [{ "billed_charge": 53.28, "npi": [1174882948] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37345.97, "providers": [{ "billed_charge": 3442.80, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF LACTIC ACID", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83605", "description": "LACTATE (LACTIC ACID)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1076.17, "providers": [{ "billed_charge": 157.30, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1518.00, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] }, { "allowed_amount": 51.60, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] } ] } ] }, { "name": "LACTATE (LD) (LDH) ENZYME", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83615", "description": "LACTATE DEHYDROGENASE (LD), (LDH);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 22963.95, "providers": [{ "billed_charge": 3100.02, "npi": [1356409379] } ] }, { "allowed_amount": 213.90, "providers": [{ "billed_charge": 140.40, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 623.15, "providers": [{ "billed_charge": 116.61, "npi": [1730119553] } ] }, { "allowed_amount": 794.67, "providers": [{ "billed_charge": 77.74, "npi": [1730119553] } ] }, { "allowed_amount": 924.75, "providers": [{ "billed_charge": 272.09, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 602.40, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] }, { "allowed_amount": 280.00, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 559.23, "providers": [{ "billed_charge": 72.36, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN(A)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83695", "description": "LIPOPROTEIN (A)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8780.93, "providers": [{ "billed_charge": 1562.48, "npi": [1720279805] } ] } ] } ] }, { "name": "LIPOPROTEIN BLD QUAN PART", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83704", "description": "LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S) (EG, BY NUCLEAR MAGNETIC RESONANC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 857.20, "providers": [{ "billed_charge": 784.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1750.33, "providers": [{ "billed_charge": 887.05, "npi": [1730119553] } ] }, { "allowed_amount": 545.52, "providers": [{ "billed_charge": 146.50, "npi": [1730119553] } ] }, { "allowed_amount": 24979.37, "providers": [{ "billed_charge": 3183.63, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 619.60, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] }, { "allowed_amount": 15372.02, "providers": [{ "billed_charge": 1505.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1183.94, "providers": [{ "billed_charge": 140.70, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 799.23, "providers": [{ "billed_charge": 98.00, "npi": [1316984388] } ] }, { "allowed_amount": 286.98, "providers": [{ "billed_charge": 71.00, "npi": [1316984388] } ] }, { "allowed_amount": 291.65, "providers": [{ "billed_charge": 23.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 51572.27, "providers": [{ "billed_charge": 6993.00, "npi": [1356409379] } ] }, { "allowed_amount": 451.33, "providers": [{ "billed_charge": 262.05, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6337.00, "providers": [{ "billed_charge": 182.88, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2262.98, "providers": [{ "billed_charge": 1444.80, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1318.53, "providers": [{ "billed_charge": 115.08, "npi": [1730119553] } ] }, { "allowed_amount": 17473.20, "providers": [{ "billed_charge": 635.80, "npi": [1730119553] } ] }, { "allowed_amount": 537.46, "providers": [{ "billed_charge": 32.88, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 30061.48, "providers": [{ "billed_charge": 2955.88, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6364.80, "providers": [{ "billed_charge": 185.20, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2365.97, "providers": [{ "billed_charge": 730.10, "npi": [1720279805] } ] } ] } ] }, { "name": "PROCALCITONIN (PCT)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84145", "description": "PROCALCITONIN (PCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.17, "providers": [{ "billed_charge": 176.41, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24308.11, "providers": [{ "billed_charge": 7445.30, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF SEX HORMONE GLOBUL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84270", "description": "SEX HORMONE BINDING GLOBULIN (SHBG)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.00, "providers": [{ "billed_charge": 23.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FREE TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84402", "description": "TESTOSTERONE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 495.21, "providers": [{ "billed_charge": 199.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 824.03, "providers": [{ "billed_charge": 622.29, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6497.51, "providers": [{ "billed_charge": 2258.16, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 392.78, "providers": [{ "billed_charge": 170.40, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37605.31, "providers": [{ "billed_charge": 5430.04, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.62, "providers": [{ "billed_charge": 167.28, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 195.09, "providers": [{ "billed_charge": 49.48, "npi": [1174882948] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 98.58, "providers": [{ "billed_charge": 62.37, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20513.11, "providers": [{ "billed_charge": 7702.80, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37481.87, "providers": [{ "billed_charge": 6788.32, "npi": [1720279805] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1507.81, "providers": [{ "billed_charge": 474.32, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TROPONIN, QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84484", "description": "TROPONIN, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3668.97, "providers": [{ "billed_charge": 185.70, "npi": [1730119553] } ] }, { "allowed_amount": 596.85, "providers": [{ "billed_charge": 76.23, "npi": [1730119553] } ] }, { "allowed_amount": 642.74, "providers": [{ "billed_charge": 44.96, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 750.80, "providers": [{ "billed_charge": 350.00, "npi": [1174113534] } ] }, { "allowed_amount": 919.38, "providers": [{ "billed_charge": 175.00, "npi": [1174113534] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2111.96, "providers": [{ "billed_charge": 142.38, "npi": [1720279805] } ] } ] } ] }, { "name": "BL SMEAR W/DIFF WBC COUNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85007", "description": "BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7354.04, "providers": [{ "billed_charge": 628.80, "npi": [1356409379] } ] }, { "allowed_amount": 3.78, "providers": [{ "billed_charge": 52.40, "npi": [1356409379] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 43331.19, "providers": [{ "billed_charge": 2680.87, "npi": [1730119553] } ] }, { "allowed_amount": 2079.39, "providers": [{ "billed_charge": 389.92, "npi": [1730119553] } ] }, { "allowed_amount": 3850.00, "providers": [{ "billed_charge": 748.84, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4238.20, "providers": [{ "billed_charge": 960.00, "npi": [1174113534] } ] }, { "allowed_amount": 25.28, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] }, { "allowed_amount": 11629.89, "providers": [{ "billed_charge": 2124.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.46, "providers": [{ "billed_charge": 38.65, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.80, "providers": [{ "billed_charge": 45.38, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2570.15, "providers": [{ "billed_charge": 688.37, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 905.37, "providers": [{ "billed_charge": 364.00, "npi": [1316984388] } ] }, { "allowed_amount": 3969.85, "providers": [{ "billed_charge": 1749.00, "npi": [1316984388] } ] }, { "allowed_amount": 1016.08, "providers": [{ "billed_charge": 227.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40530.38, "providers": [{ "billed_charge": 8676.80, "npi": [1720279805] } ] }, { "allowed_amount": 2795.44, "providers": [{ "billed_charge": 924.80, "npi": [1861018574] } ] }, { "allowed_amount": 1725.56, "providers": [{ "billed_charge": 734.40, "npi": [1578549044] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 665.81, "providers": [{ "billed_charge": 301.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "800151023" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 295.43, "providers": [{ "billed_charge": 36.75, "npi": [1316196892] } ] }, { "allowed_amount": 3719.04, "providers": [{ "billed_charge": 85.75, "npi": [1316196892] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 309.96, "providers": [{ "billed_charge": 161.35, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 49346.14, "providers": [{ "billed_charge": 9904.09, "npi": [1356409379] } ] }, { "allowed_amount": 1332.25, "providers": [{ "billed_charge": 1557.40, "npi": [1356409379] } ] }, { "allowed_amount": 457.07, "providers": [{ "billed_charge": 479.20, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 139.92, "providers": [{ "billed_charge": 79.35, "npi": [1942257191] } ] }, { "allowed_amount": 10428.63, "providers": [{ "billed_charge": 1140.49, "npi": [1942257191] } ] }, { "allowed_amount": 164.14, "providers": [{ "billed_charge": 105.80, "npi": [1942257191] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6754.78, "providers": [{ "billed_charge": 358.80, "npi": [1730119553] } ] }, { "allowed_amount": 114.35, "providers": [{ "billed_charge": 17.94, "npi": [1730119553] } ] }, { "allowed_amount": 79.80, "providers": [{ "billed_charge": 53.82, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1335.94, "providers": [{ "billed_charge": 240.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 964.21, "providers": [{ "billed_charge": 189.00, "npi": [1316984388] } ] }, { "allowed_amount": 6171.07, "providers": [{ "billed_charge": 1071.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 150.21, "providers": [{ "billed_charge": 45.30, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": 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"billed_charge": 15108.00, "npi": [1710315353] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 113204.45, "providers": [{ "billed_charge": 106464.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 47072.72, "providers": [{ "billed_charge": 54312.00, "npi": [1447288345] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 14903.00, "providers": [{ "billed_charge": 17062.00, "npi": [1104889138] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 13728.00, "providers": [{ "billed_charge": 15040.00, "npi": [1861432627] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 14192.86, "providers": [{ "billed_charge": 18391.00, "npi": [1477508984] } ] }, { "allowed_amount": 9608.31, "providers": [{ "billed_charge": 11574.00, "npi": [1578720124] } ] }, { "allowed_amount": 29284.91, "providers": [{ "billed_charge": 32924.00, "npi": [1346265154] } ] }, { "allowed_amount": 1015.94, "providers": [{ "billed_charge": 1286.00, "npi": [1306145404] } ] }, { "allowed_amount": 18500.67, "providers": [{ "billed_charge": 20834.00, "npi": [1407886138] } ] }, { "allowed_amount": 34725.88, "providers": [{ "billed_charge": 43728.00, "npi": [1780625871] } ] }, { "allowed_amount": 98636.03, "providers": [{ "billed_charge": 114079.00, "npi": [1326346438] } ] }, { "allowed_amount": 35840.07, "providers": [{ "billed_charge": 41156.00, "npi": [1881632149] } ] } ] }, { "tin": { "type": "ein", "value": "943278555" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17106.00, "providers": [{ "billed_charge": 17010.00, "npi": [1134110661] } ] } ] }, { "tin": { "type": "ein", "value": "953192932" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2220.00, "providers": [{ "billed_charge": 2220.00, "npi": [1871535286] } ] } ] }, { "tin": { "type": "ein", "value": "953056292" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1635.90, "providers": [{ "billed_charge": 2870.00, "npi": [1740214733] } ] } ] }, { "tin": { "type": "ein", "value": "990970557" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 11617.50, "providers": [{ "billed_charge": 12150.00, "npi": [1376305755] } ] } ] }, { "tin": { "type": "ein", "value": "954873894" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1271.37, "providers": [{ "billed_charge": 1609.33, "npi": [1235176702] } ] } ] }, { "tin": { "type": "ein", "value": "274096788" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6771.19, "providers": [{ "billed_charge": 10287.63, "npi": [1972953230] } ] } ] } ] }, { "name": "CRITICAL CARE, FIRST HOUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99291", "description": "CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "222785804" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4891.20, "providers": [{ "billed_charge": 8152.00, "npi": [1639264682] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "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": "821938082" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 480.50, "providers": [{ "billed_charge": 840.00, "npi": [1497265565] } ] } ] }, { "tin": { "type": "ein", "value": "821053156" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 6697.58, "providers": [{ "billed_charge": 3300.00, "npi": [1699288993] } ] } ] }, { "tin": { "type": "ein", "value": "842599550" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1891.36, "providers": [{ "billed_charge": 400.00, "npi": [1447806278] } ] } ] }, { "tin": { "type": "ein", "value": "994920004" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 338.28, "providers": [{ "billed_charge": 690.00, "npi": [1649091026] } ] } ] }, { "tin": { "type": "ein", "value": "208748539" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 8593.13, "providers": [{ "billed_charge": 7920.00, "npi": [1720261506] } ] } ] } ] }, { "name": "HOME VISIT EST PATIENT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99349", "description": "HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462394520" }, "service_code": ["13"], "billing_class": "professional", "payments": [{ "allowed_amount": 679.14, "providers": [{ "billed_charge": 875.00, "npi": [1063825289] } ] } ] } ] }, { "name": "PROLNG OFF/OP E/M EA 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99417", "description": "PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273081619" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2495.55, "providers": [{ "billed_charge": 600.00, "npi": [1912362567] } ] } ] }, { "tin": { "type": "ein", "value": "923084561" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 430.10, "providers": [{ "billed_charge": 384.00, "npi": [1649975681] } ] } ] }, { "tin": { "type": "ein", "value": "990998900" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3236.00, "providers": [{ "billed_charge": 5346.00, "npi": [1780435529] } ] } ] } ] }, { "name": "PED CRIT CARE AGE 2-5 SUBSQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99476", "description": "SUBSEQUENT INPATIENT PEDIATRIC CRITICAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A CRITIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "232592835" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 117490.80, "providers": [{ "billed_charge": 68458.00, "npi": [1497850291] } ] } ] } ] }, { "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": "421406317" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.00, "providers": [{ "billed_charge": 204.00, "npi": [1234567893] } ] } ] } ] }, { "name": "TUBING FOR BREAST PUMP REPLA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4281", "description": "TUBING FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1660.62, "providers": [{ "billed_charge": 510.14, "npi": [1477222834] } ] } ] } ] }, { "name": "ADAPTER FOR BREAST PUMP REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4282", "description": "ADAPTER FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1852.74, "providers": [{ "billed_charge": 572.00, "npi": [1477222834] } ] } ] } ] }, { "name": "CAP BRST PUMP BOTLE REPLCMNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4283", "description": "CAP FOR BREAST PUMP BOTTLE, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1780.80, "providers": [{ "billed_charge": 133.04, "npi": [1477222834] } ] } ] } ] }, { "name": "BRST SHIELD&SPLSH PROTCTR PU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4284", "description": "BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1545.55, "providers": [{ "billed_charge": 205.43, "npi": [1477222834] } ] } ] } ] }, { "name": "POLYCARBATE BOTTLE BRST PUMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4285", "description": "POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1911.45, "providers": [{ "billed_charge": 203.76, "npi": [1477222834] } ] } ] } ] }, { "name": "LOCKING RING BRST PUMP REPLC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4286", "description": "LOCKING RING FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1722.35, "providers": [{ "billed_charge": 146.20, "npi": [1477222834] } ] } ] } ] }, { "name": "Disposable collection and storage bag for breast milk, any size, any type, each", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4287", "description": "Disposable collection and storage bag for breast milk, any size, any type, each", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4147.34, "providers": [{ "billed_charge": 2471.70, "npi": [1477222834] } ] } ] } ] }, { "name": "ELEC STIM SPPLS 2 LD PER MTH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4595", "description": "ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G., TENS, NMES)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 17765.41, "providers": [{ "billed_charge": 21471.03, "npi": [1770511552] } ] } ] } ] }, { "name": "TUBING W/INTGR HEAT ELEM W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4604", "description": "TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8197.96, "providers": [{ "billed_charge": 1263.11, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1953.03, "providers": [{ "billed_charge": 550.00, "npi": [1144767542] } ] } ] } ] }, { "name": "REPL BATTRY TRNSQ ELEC STIM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4630", "description": "REPLACEMENT BATTERIES, MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL STIMULATOR, OWNED BY PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 239.96, "providers": [{ "billed_charge": 39.96, "npi": [1770511552] } ] } ] } ] }, { "name": "FULL FCE MASK POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7030", "description": "FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.54, "providers": [{ "billed_charge": 45.00, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3669.08, "providers": [{ "billed_charge": 1237.54, "npi": [1477222834] } ] } ] } ] }, { "name": "FCE MASK INTERFCE REPL FULL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7031", "description": "FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3833.76, "providers": [{ "billed_charge": 1680.80, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1083.09, "providers": [{ "billed_charge": 1670.00, "npi": [1144767542] } ] } ] } ] }, { "name": "CUSHN NASAL MASK INTF REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7032", "description": "CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 629.22, "providers": [{ "billed_charge": 347.53, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1109.88, "providers": [{ "billed_charge": 2200.00, "npi": [1144767542] } ] } ] } ] }, { "name": "PILLW NASL CANNULA TYPE INTF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7033", "description": "PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2165.64, "providers": [{ "billed_charge": 2730.00, "npi": [1144767542] } ] } ] } ] }, { "name": "NASL INTERFCE POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7034", "description": "NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2435.06, "providers": [{ "billed_charge": 1195.05, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2821.09, "providers": [{ "billed_charge": 811.05, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3770.30, "providers": [{ "billed_charge": 2460.00, "npi": [1144767542] } ] } ] } ] }, { "name": "HEADGEAR USED W/POS ARWAY PR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7035", "description": "HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6611.41, "providers": [{ "billed_charge": 1376.86, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5641.64, "providers": [{ "billed_charge": 448.34, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3393.10, "providers": [{ "billed_charge": 605.00, "npi": [1144767542] } ] } ] } ] }, { "name": "TUBING USED W/POS ARWAY PRES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7037", "description": "TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3676.12, "providers": [{ "billed_charge": 560.82, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 799.49, "providers": [{ "billed_charge": 260.00, "npi": [1144767542] } ] } ] } ] }, { "name": "FLTR DISPBL W/POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7038", "description": "FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5889.53, "providers": [{ "billed_charge": 617.35, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 12869.64, "providers": [{ "billed_charge": 667.52, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7049.99, "providers": [{ "billed_charge": 2450.00, "npi": [1144767542] } ] } ] } ] }, { "name": "WATR CHAMB HUMDIFIR USED W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7046", "description": "WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2547.46, "providers": [{ "billed_charge": 125.33, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1446.96, "providers": [{ "billed_charge": 285.00, "npi": [1144767542] } ] } ] } ] }, { "name": "INJ GADOTERATE MEGLMNE 0.1ML", "billing_code_type": 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