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"providers": [{ "billed_charge": 680.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1005.53, "providers": [{ "billed_charge": 2173.47, "npi": [1932145778] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 36223.91, "providers": [{ "billed_charge": 2605.97, "npi": [1730119553] } ] }, { "allowed_amount": 2903.64, "providers": [{ "billed_charge": 728.59, "npi": [1730119553] } ] }, { "allowed_amount": 1785.82, "providers": [{ "billed_charge": 384.39, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3398.40, "providers": [{ "billed_charge": 744.00, "npi": [1174113534] } ] }, { "allowed_amount": 130.72, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] }, { "allowed_amount": 12166.10, "providers": [{ "billed_charge": 870.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 185.06, "providers": [{ "billed_charge": 32.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3635.98, "providers": [{ "billed_charge": 1205.97, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1072.27, "providers": [{ "billed_charge": 468.00, "npi": [1316984388] } ] }, { "allowed_amount": 3477.14, "providers": [{ "billed_charge": 624.00, "npi": [1316984388] } ] }, { "allowed_amount": 6421.31, "providers": [{ "billed_charge": 3159.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.78, "providers": [{ "billed_charge": 30.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "800151023" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.40, "providers": [{ "billed_charge": 16.35, "npi": [1316196892] } ] }, { "allowed_amount": 182.42, "providers": [{ "billed_charge": 49.05, "npi": [1316196892] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 865.93, "providers": [{ "billed_charge": 1482.48, "npi": [1356409379] } ] }, { "allowed_amount": 233.70, "providers": [{ "billed_charge": 411.80, "npi": [1356409379] } ] }, { "allowed_amount": 34113.96, "providers": [{ "billed_charge": 7713.77, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 385.18, "providers": [{ "billed_charge": 552.08, "npi": [1942257191] } ] }, { "allowed_amount": 220.32, "providers": [{ "billed_charge": 139.64, "npi": [1942257191] } ] }, { "allowed_amount": 4434.94, "providers": [{ "billed_charge": 1307.14, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "830565295" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1902.43, "providers": [{ "billed_charge": 157.09, "npi": [1972080752] } ] }, { "allowed_amount": 103.83, "providers": [{ "billed_charge": 38.53, "npi": [1972080752] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.00, "providers": [{ "billed_charge": 139.94, "npi": [1568431088] } ] }, { "allowed_amount": 869.16, "providers": [{ "billed_charge": 419.82, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2117.95, "providers": [{ "billed_charge": 1831.88, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3355.51, "providers": [{ "billed_charge": 1404.48, "npi": [1861018574] } ] }, { "allowed_amount": 677.05, "providers": [{ "billed_charge": 369.60, "npi": [1578549044] } ] }, { "allowed_amount": 49776.30, "providers": [{ "billed_charge": 14488.32, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1236.48, "providers": [{ "billed_charge": 853.97, "npi": [1063497451] } ] }, { "allowed_amount": 1036.71, "providers": [{ "billed_charge": 241.50, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1999.55, "providers": [{ "billed_charge": 638.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1326.58, "providers": [{ "billed_charge": 892.77, "npi": [1043256886] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "HCPCS", "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": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 722.26, "providers": [{ "billed_charge": 382.99, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5952.56, "providers": [{ "billed_charge": 3321.93, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1605.18, "providers": [{ "billed_charge": 420.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 120286.85, "providers": [{ "billed_charge": 31168.55, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1515.06, "providers": [{ "billed_charge": 2651.56, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 943.62, "providers": [{ "billed_charge": 528.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2650.55, "providers": [{ "billed_charge": 2160.90, "npi": [1063497451] } ] }, { "allowed_amount": 635.19, "providers": [{ "billed_charge": 707.80, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5580.54, "providers": [{ "billed_charge": 6615.33, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 557.82, "providers": [{ "billed_charge": 302.50, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3101.00, "providers": [{ "billed_charge": 4371.27, "npi": [1932145778] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "HCPCS", "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": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12638.00, "providers": [{ "billed_charge": 2358.65, "npi": [1356409379] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "HCPCS", "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": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1085.18, "providers": [{ "billed_charge": 686.40, "npi": [1720279805] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1889.53, "providers": [{ "billed_charge": 815.18, "npi": [1730119553] } ] }, { "allowed_amount": 777.99, "providers": [{ "billed_charge": 276.98, "npi": [1730119553] } ] }, { "allowed_amount": 714.06, "providers": [{ "billed_charge": 179.40, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 467.29, "providers": [{ "billed_charge": 427.00, "npi": [1730466590] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1200.20, "providers": [{ "billed_charge": 105.00, "npi": [1174113534] } ] }, { "allowed_amount": 2276.80, "providers": [{ "billed_charge": 518.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 117979.46, "providers": [{ "billed_charge": 111157.28, "npi": [1508499393] } ] } ] }, { "tin": { "type": "ein", "value": "452215107" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4723.02, "providers": [{ "billed_charge": 5592.60, "npi": [1801226543] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34547.28, "providers": [{ "billed_charge": 290041.84, "npi": [1063011898] } ] } ] }, { "tin": { "type": "ein", "value": "920971049" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2053.50, "providers": [{ "billed_charge": 9500.00, "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": 5099.97, "providers": [{ "billed_charge": 132.58, "npi": [1730119553] } ] }, { "allowed_amount": 1485.73, "providers": [{ "billed_charge": 61.92, "npi": [1730119553] } ] }, { "allowed_amount": 165.13, "providers": [{ "billed_charge": 38.90, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.60, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] }, { "allowed_amount": 507.60, "providers": [{ "billed_charge": 150.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.81, "providers": [{ "billed_charge": 48.96, "npi": [1861018574] } ] }, { "allowed_amount": 29285.94, "providers": [{ "billed_charge": 2252.16, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 430.86, "providers": [{ "billed_charge": 50.00, "npi": [1316984388] } ] }, { "allowed_amount": 1383.08, "providers": [{ "billed_charge": 157.00, "npi": [1316984388] } ] }, { "allowed_amount": 275.97, "providers": [{ "billed_charge": 44.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 712.69, "providers": [{ "billed_charge": 451.84, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4518.86, "providers": [{ "billed_charge": 239.56, "npi": [1356409379] } ] }, { "allowed_amount": 86.17, "providers": [{ "billed_charge": 97.32, "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": 3663.48, "providers": [{ "billed_charge": 186.01, "npi": [1720279805] } ] } ] } ] }, { "name": "ANES LWR INTST SCR COLSC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "812", "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; SCRE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834708723" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 3126.10, "providers": [{ "billed_charge": 4750.00, "npi": [1487214698] } ] } ] } ] }, { "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": 12636.54, "providers": [{ "billed_charge": 18217.20, "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": 6318.27, "providers": [{ "billed_charge": 9108.60, "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": 82319.38, "providers": [{ "billed_charge": 3048.39, "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": 41031.11, "providers": [{ "billed_charge": 41933.64, "npi": [1720279805] } ] } ] } ] }, { "name": "HEMO/OP OR HOME", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "820", "description": "HEMODIALYSIS - OUTPT OR HOME - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 685844.28, "providers": [{ "billed_charge": 48286.00, "npi": [1912446865] } ] } ] } ] }, { "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": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.74, "providers": [{ "billed_charge": 39.46, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13841.05, "providers": [{ "billed_charge": 2847.95, "npi": [1720279805] } ] } ] } ] }, { "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": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1629348.31, "providers": [{ "billed_charge": 304757.70, "npi": [1124682166] } ] } ] }, { "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 502800.00, "providers": [{ "billed_charge": 74000.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "263563865" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 197822.98, "providers": [{ "billed_charge": 17664.00, "npi": [1437683877] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 804534.82, "providers": [{ "billed_charge": 105569.08, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "204399694" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 142746.00, "providers": [{ "billed_charge": 36864.00, "npi": [1689693319] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 701038.65, "providers": [{ "billed_charge": 556416.00, "npi": [1609217157] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22", "99"], "billing_class": "professional", "payments": [{ "allowed_amount": 907812.85, "providers": [{ "billed_charge": 60357.50, "npi": [1326282484] } ] }, { "allowed_amount": 7780803.78, "providers": [{ "billed_charge": 473977.23, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "932718345" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 327338.06, "providers": [{ "billed_charge": 378088.52, "npi": [1538946397] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2176241.10, "providers": [{ "billed_charge": 193824.00, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "770462755" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2898743.60, "providers": [{ "billed_charge": 248300.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "953372911" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 209796.56, "providers": [{ "billed_charge": 35820.00, "npi": [1902869035] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5242546.07, "providers": [{ "billed_charge": 291456.00, "npi": [1386180859] } ] } ] }, { "tin": { "type": "ein", "value": "203344171" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 141752.00, "providers": [{ "billed_charge": 49152.00, "npi": [1194916205] } ] } ] } ] }, { "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": 10920.55, "providers": [{ "billed_charge": 3617.18, "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": 2360.48, "providers": [{ "billed_charge": 210.84, "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 SIMULTANEOU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 936.25, "providers": [{ "billed_charge": 390.04, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1234.21, "providers": [{ "billed_charge": 909.46, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 80146.80, "providers": [{ "billed_charge": 36778.00, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 558.73, "providers": [{ "billed_charge": 255.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.71, "providers": [{ "billed_charge": 286.65, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2197.89, "providers": [{ "billed_charge": 2344.48, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.23, "providers": [{ "billed_charge": 276.66, "npi": [1932145778] } ] } ] } ] }, { "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": 722.30, "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": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 226.23, "providers": [{ "billed_charge": 106.51, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14745.63, "providers": [{ "billed_charge": 1849.26, "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": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 481.58, "providers": [{ "billed_charge": 108.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22104.82, "providers": [{ "billed_charge": 4961.32, "npi": [1720279805] } ] } ] } ] }, { "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": 5971.26, "providers": [{ "billed_charge": 2884.12, "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": 39296.71, "providers": [{ "billed_charge": 9160.32, "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": 5913.14, "providers": [{ "billed_charge": 1337.70, "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": 1015.88, "providers": [{ "billed_charge": 447.15, "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": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1207.64, "providers": [{ "billed_charge": 287.89, "npi": [1730119553] } ] }, { "allowed_amount": 3.54, "providers": [{ "billed_charge": 17.49, "npi": [1730119553] } ] } ] }, { "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": 15815.90, "providers": [{ "billed_charge": 3281.40, "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": 16802.03, "providers": [{ "billed_charge": 682.11, "npi": [1730119553] } ] }, { "allowed_amount": 53.20, "providers": [{ "billed_charge": 34.98, "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": 10650.22, "providers": [{ "billed_charge": 3041.84, "npi": [1730119553] } ] }, { "allowed_amount": 5.42, "providers": [{ "billed_charge": 64.28, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "880107050" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 706.29, "providers": [{ "billed_charge": 35.00, "npi": [1083675169] } ] } ] } ] }, { "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": 5274.36, "providers": [{ "billed_charge": 1365.63, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1132.28, "providers": [{ "billed_charge": 194.46, "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": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 518.90, "providers": [{ "billed_charge": 56.58, "npi": [1730119553] } ] }, { "allowed_amount": 114.90, "providers": [{ "billed_charge": 35.88, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 324.78, "providers": [{ "billed_charge": 103.54, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5075.68, "providers": [{ "billed_charge": 2473.45, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1109.42, "providers": [{ "billed_charge": 968.45, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 662.40, "providers": [{ "billed_charge": 170.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 111306.05, "providers": [{ "billed_charge": 19544.25, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1939.51, "providers": [{ "billed_charge": 922.85, "npi": [1063497451] } ] }, { "allowed_amount": 55.54, "providers": [{ "billed_charge": 69.30, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3570.91, "providers": [{ "billed_charge": 2378.65, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 275.49, "providers": [{ "billed_charge": 77.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1934.30, "providers": [{ "billed_charge": 1223.30, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.71, "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": 34618.11, "providers": [{ "billed_charge": 3624.00, "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": 1339.01, "providers": [{ "billed_charge": 194.45, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2401.20, "providers": [{ "billed_charge": 120.00, "npi": [1174113534] } ] }, { "allowed_amount": 608.40, "providers": [{ "billed_charge": 120.00, "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": 64.08, "providers": [{ "billed_charge": 46.80, "npi": [1356409379] } ] }, { "allowed_amount": 28108.69, "providers": [{ "billed_charge": 3515.61, "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": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 220.87, "providers": [{ "billed_charge": 77.74, "npi": [1730119553] } ] }, { "allowed_amount": 926.35, "providers": [{ "billed_charge": 133.80, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.20, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] }, { "allowed_amount": 566.20, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 510.64, "providers": [{ "billed_charge": 120.60, "npi": [1720279805] } ] }, { "allowed_amount": 227.56, "providers": [{ "billed_charge": 48.24, "npi": [1861018574] } ] } ] } ] }, { "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": 8812.48, "providers": [{ "billed_charge": 1954.68, "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": 1056.80, "providers": [{ "billed_charge": 1008.00, "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": 41085.76, "providers": [{ "billed_charge": 3809.88, "npi": [1730119553] } ] }, { "allowed_amount": 319.09, "providers": [{ "billed_charge": 73.25, "npi": [1730119553] } ] }, { "allowed_amount": 1536.53, "providers": [{ "billed_charge": 732.50, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 24587.56, "providers": [{ "billed_charge": 1145.00, "npi": [1174113534] } ] }, { "allowed_amount": 426.00, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 101.55, "providers": [{ "billed_charge": 48.00, "npi": [1316984388] } ] }, { "allowed_amount": 2394.46, "providers": [{ "billed_charge": 365.00, "npi": [1316984388] } ] }, { "allowed_amount": 291.65, "providers": [{ "billed_charge": 23.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 709.20, "providers": [{ "billed_charge": 140.70, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.02, "providers": [{ "billed_charge": 104.82, "npi": [1356409379] } ] }, { "allowed_amount": 42442.12, "providers": [{ "billed_charge": 6102.03, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7851.22, "providers": [{ "billed_charge": 418.89, "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": 3981.01, "providers": [{ "billed_charge": 2456.16, "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": 1522.89, "providers": [{ "billed_charge": 180.84, "npi": [1730119553] } ] }, { "allowed_amount": 226.43, "providers": [{ "billed_charge": 16.44, "npi": [1730119553] } ] }, { "allowed_amount": 17710.11, "providers": [{ "billed_charge": 450.95, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 23903.53, "providers": [{ "billed_charge": 2581.48, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6202.26, "providers": [{ "billed_charge": 314.32, "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": 490.65, "providers": [{ "billed_charge": 219.03, "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": 2269.50, "providers": [{ "billed_charge": 882.05, "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": 22909.65, "providers": [{ "billed_charge": 7457.50, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 316.51, "providers": [{ "billed_charge": 43.26, "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": 324.40, "providers": [{ "billed_charge": 58.00, "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": 1041.08, "providers": [{ "billed_charge": 219.00, "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": 379.11, "providers": [{ "billed_charge": 410.75, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9500.07, "providers": [{ "billed_charge": 3093.22, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 148.35, "providers": [{ "billed_charge": 237.80, "npi": [1043256886] } ] } ] } ] }, { "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": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31168.77, "providers": [{ "billed_charge": 5177.48, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1140.44, "providers": [{ "billed_charge": 1012.04, "npi": [1043256886] } ] } ] } ] }, { "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": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21385.36, "providers": [{ "billed_charge": 8055.60, "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": 35742.56, "providers": [{ "billed_charge": 7145.60, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY, TRIIODOTHYRONINE (T3)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84480", "description": "TRIIODOTHYRONINE T3; TOTAL (TT-3)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 123.38, "providers": [{ "billed_charge": 49.63, "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": 277.36, "providers": [{ "billed_charge": 118.58, "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": 3630.53, "providers": [{ "billed_charge": 242.38, "npi": [1730119553] } ] }, { "allowed_amount": 438.86, "providers": [{ "billed_charge": 76.23, "npi": [1730119553] } ] }, { "allowed_amount": 68.77, "providers": [{ "billed_charge": 95.78, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 316.98, "providers": [{ "billed_charge": 70.00, "npi": [1174113534] } ] }, { "allowed_amount": 783.40, "providers": [{ "billed_charge": 315.00, "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": 1674.82, "providers": [{ "billed_charge": 237.30, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2653.88, "providers": [{ "billed_charge": 248.92, "npi": [1356409379] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.82, "providers": [{ "billed_charge": 52.68, "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", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.78, "providers": [{ "billed_charge": 52.40, "npi": [1356409379] } ] }, { "allowed_amount": 19.20, "providers": [{ "billed_charge": 26.20, "npi": [1356409379] } ] }, { "allowed_amount": 8935.62, "providers": [{ "billed_charge": 1149.08, "npi": [1356409379] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "HCPCS", 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[{ "billed_charge": 90.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 633.76, "providers": [{ "billed_charge": 96.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3231.36, "providers": [{ "billed_charge": 739.23, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.05, "providers": [{ "billed_charge": 28.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1710.85, "providers": [{ "billed_charge": 338.00, "npi": [1316984388] } ] }, { "allowed_amount": 958.57, "providers": [{ "billed_charge": 420.00, "npi": [1316984388] } ] }, { "allowed_amount": 4178.73, "providers": [{ "billed_charge": 1983.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "800151023" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4953.99, "providers": [{ "billed_charge": 98.00, "npi": [1316196892] } ] }, { "allowed_amount": 6.77, "providers": [{ "billed_charge": 12.25, "npi": [1316196892] } ] }, { "allowed_amount": 58.43, "providers": [{ "billed_charge": 12.25, "npi": [1316196892] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 355.66, "providers": [{ "billed_charge": 359.40, "npi": [1356409379] } ] }, { "allowed_amount": 870.66, "providers": [{ "billed_charge": 1257.90, "npi": [1356409379] } ] }, { "allowed_amount": 38115.29, "providers": [{ "billed_charge": 8047.19, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.55, "providers": [{ "billed_charge": 26.45, "npi": [1942257191] } ] }, { "allowed_amount": 19597.54, "providers": [{ "billed_charge": 1246.29, "npi": [1942257191] } ] }, { "allowed_amount": 383.08, "providers": [{ "billed_charge": 246.14, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "830565295" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.36, "providers": [{ "billed_charge": 21.84, "npi": [1972080752] } ] }, { "allowed_amount": 45.20, "providers": [{ "billed_charge": 21.84, "npi": [1972080752] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 180.16, "providers": [{ "billed_charge": 45.38, "npi": [1568431088] } ] }, { "allowed_amount": 150.24, "providers": [{ "billed_charge": 90.76, "npi": [1568431088] } ] }, { "allowed_amount": 269.88, "providers": [{ "billed_charge": 181.52, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3524.85, "providers": [{ "billed_charge": 1115.20, "npi": [1861018574] } ] }, { "allowed_amount": 1552.02, "providers": [{ "billed_charge": 761.60, "npi": [1578549044] } ] }, { "allowed_amount": 41770.55, "providers": [{ "billed_charge": 9356.80, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1535.99, "providers": [{ "billed_charge": 216.00, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 213.97, "providers": [{ "billed_charge": 65.10, "npi": [1538144910] } ] }, { "allowed_amount": 1219.71, "providers": [{ "billed_charge": 130.20, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 795.13, "providers": [{ "billed_charge": 344.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 547.49, "providers": [{ "billed_charge": 163.95, "npi": [1043256886] } ] } ] } ] }, { "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", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7278.20, "providers": [{ "billed_charge": 431.94, "npi": [1730119553] } ] }, { "allowed_amount": 131.44, "providers": [{ "billed_charge": 89.70, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 967.70, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 741.68, "providers": [{ "billed_charge": 213.00, "npi": [1316984388] } ] }, { "allowed_amount": 5216.05, "providers": [{ "billed_charge": 969.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 177.23, "providers": [{ "billed_charge": 45.30, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": 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"ein", "value": "263447487" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.37, "providers": [{ "billed_charge": 0.00, "npi": [1215181300] } ] }, { "allowed_amount": 118.61, "providers": [{ "billed_charge": 0.00, "npi": [1215181300] } ] } ] } ] } ] }