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PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10937.20, "providers": [{ "billed_charge": 27160.32, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.64, "providers": [{ "billed_charge": 205.92, "npi": [1234567893] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80061", "description": "LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10837.50, "providers": [{ "billed_charge": 27034.41, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 334.33, "providers": [{ "billed_charge": 1000.48, "npi": [1234567893] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80069", "description": "RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.05, "providers": [{ "billed_charge": 199.64, "npi": [1811154388] } ] } ] } ] }, { "name": "ACUTE HEPATITIS PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80074", "description": "ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 400.08, "providers": [{ "billed_charge": 952.60, "npi": [1811154388] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80076", "description": "HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 995.28, "providers": [{ "billed_charge": 2442.83, "npi": [1811154388] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80307", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5220.00, "providers": [{ "billed_charge": 12800.84, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "262961334" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.54, "providers": [{ "billed_charge": 372.84, "npi": [1811883184] } ] } ] }, { "tin": { "type": "ein", "value": "371874451" }, "service_code": ["57"], "billing_class": "professional", "payments": [{ "allowed_amount": 248.56, "providers": [{ "billed_charge": 800.00, "npi": [1265666218] } ] }, { "allowed_amount": 1426.14, "providers": [{ "billed_charge": 5400.00, "npi": [1700415320] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 97.68, "providers": [{ "billed_charge": 250.43, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.90, "providers": [{ "billed_charge": 51.75, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 954.62, "providers": [{ "billed_charge": 2392.92, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12846.40, "providers": [{ "billed_charge": 31701.60, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 634.92, "providers": [{ "billed_charge": 1900.32, "npi": [1234567893] } ] } ] } ] }, { "name": "TOTAL CORTISOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82533", "description": "CORTISOL; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 251.02, "providers": [{ "billed_charge": 570.50, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF CK (CPK)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82550", "description": "CREATINE KINASE (CK), (CPK); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.44, "providers": [{ "billed_charge": 91.14, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1029.50, "providers": [{ "billed_charge": 2564.10, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3166.50, "providers": [{ "billed_charge": 7826.52, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.66, "providers": [{ "billed_charge": 655.98, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 665.04, "providers": [{ "billed_charge": 1620.52, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1087.56, "providers": [{ "billed_charge": 2603.33, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.10, "providers": [{ "billed_charge": 102.25, "npi": [1234567893] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1584.66, "providers": [{ "billed_charge": 3939.60, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.70, "providers": [{ "billed_charge": 44.10, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.32, "providers": [{ "billed_charge": 511.50, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 676.26, "providers": [{ "billed_charge": 1727.94, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 311.16, "providers": [{ "billed_charge": 814.88, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5680.62, "providers": [{ "billed_charge": 14331.96, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.70, "providers": [{ "billed_charge": 655.65, "npi": [1234567893] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.00, "providers": [{ "billed_charge": 34.29, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 616.08, "providers": [{ "billed_charge": 1513.98, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.64, "providers": [{ "billed_charge": 106.81, "npi": [1234567893] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 685.44, "providers": [{ "billed_charge": 1678.08, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.65, "providers": [{ "billed_charge": 20.67, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.88, "providers": [{ "billed_charge": 616.40, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 693.48, "providers": [{ "billed_charge": 1609.92, "npi": [1811154388] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.91, "providers": [{ "billed_charge": 465.12, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.12, "providers": [{ "billed_charge": 102.76, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1914.89, "providers": [{ "billed_charge": 4697.42, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1566.12, "providers": [{ "billed_charge": 3869.58, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.59, "providers": [{ "billed_charge": 121.77, "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11501.28, "providers": [{ "billed_charge": 28543.20, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 403.24, "providers": [{ "billed_charge": 965.58, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 126.60, "providers": [{ "billed_charge": 316.40, "npi": [1811154388] } ] } ] } ] }, { "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": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5407.36, "providers": [{ "billed_charge": 13341.09, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.78, "providers": [{ "billed_charge": 23.32, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85027", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1694.22, "providers": [{ "billed_charge": 4127.86, "npi": [1811154388] } ] } ] } ] }, { "name": "PROTHROMBIN TIME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85610", "description": "PROTHROMBIN TIME;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.20, "providers": [{ "billed_charge": 283.14, "npi": [1811154388] } ] } ] } ] }, { "name": "RBC SED RATE, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85652", "description": "SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ 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