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"billed_charge": 202696.46, "npi": [1871547703] } ] } ] } ] }, { "name": "ROUTINE VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.56, "providers": [{ "billed_charge": 72.00, "npi": [1942526447] } ] } ] }, { "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11536.56, "providers": [{ "billed_charge": 24052.14, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 197.96, "providers": [{ "billed_charge": 607.20, "npi": [1234567893] } ] } ] } ] }, { "name": "EMERG ROOM", "billing_code_type": "RC", 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1134.80, "npi": [1568528594] } ] } ] }, { "tin": { "type": "ein", "value": "611345363" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53912.20, "providers": [{ "billed_charge": 92198.00, "npi": [1871588772] } ] } ] }, { "tin": { "type": "ein", "value": "621757929" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3468.04, "providers": [{ "billed_charge": 7933.15, "npi": [1881785863] } ] } ] }, { "tin": { "type": "ein", "value": "610605336" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9964.87, "providers": [{ "billed_charge": 10948.00, "npi": [1124078696] } ] } ] }, { "tin": { "type": "ein", "value": "621757920" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3264.98, "providers": [{ "billed_charge": 10793.74, "npi": [1619038247] } ] } ] }, { "tin": { "type": "ein", "value": "204474637" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 606.27, "providers": [{ "billed_charge": 606.27, "npi": [1225161524] } ] } ] }, { "tin": { "type": "ein", "value": "610676546" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14984.58, "providers": [{ "billed_charge": 15555.00, "npi": [1689761942] } ] } ] }, { "tin": { "type": "ein", "value": "621757921" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18424.18, "providers": [{ "billed_charge": 47402.27, "npi": [1326107319] } ] } ] }, { "tin": { "type": "ein", "value": "610724492" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 69046.85, "providers": [{ "billed_charge": 182636.95, "npi": [1871547703] } ] } ] }, { "tin": { "type": "ein", "value": "611334601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 55128.73, "providers": [{ "billed_charge": 115922.00, "npi": [1992701429] } ] }, { "allowed_amount": 22372.47, "providers": [{ "billed_charge": 22507.00, "npi": [1740488386] } ] }, { "allowed_amount": 13020.21, "providers": [{ "billed_charge": 19314.00, "npi": [1437150984] } ] }, { "allowed_amount": 10436.80, "providers": [{ "billed_charge": 13744.00, "npi": [1861650814] } ] }, { "allowed_amount": 5342.11, "providers": [{ "billed_charge": 7913.00, "npi": [1447457775] } ] } ] }, { "tin": { "type": "ein", "value": "611238190" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4305.60, "providers": [{ "billed_charge": 12890.44, "npi": [1063484483] } ] } ] }, { "tin": { "type": "ein", "value": "610594620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14814.50, "providers": [{ "billed_charge": 20689.00, "npi": [1811922347] } ] } ] }, { "tin": { "type": "ein", "value": "610859329" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 61762.26, "providers": [{ "billed_charge": 244822.61, "npi": [1427095488] } ] } ] }, { "tin": { "type": "ein", "value": "061705652" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4028.03, "providers": [{ "billed_charge": 4163.00, "npi": [1407829567] } ] } ] } ] }, { "name": "DRUG/DETAIL CODE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "636", "description": "DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610600313" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 62.10, "providers": [{ "billed_charge": 207.00, "npi": [1346244126] } ] } ] }, { "tin": { "type": "ein", "value": "621772321" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2475.69, "providers": [{ "billed_charge": 8261.30, "npi": [1811213994] } ] } ] }, { "tin": { "type": "ein", "value": "611285331" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18.70, "providers": [{ "billed_charge": 62.32, "npi": [1346247962] } ] } ] }, { "tin": { "type": "ein", "value": "611345363" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1552.76, "providers": [{ "billed_charge": 4957.25, "npi": [1871588772] } ] } ] }, { "tin": { "type": "ein", "value": "621757929" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1755.24, "providers": [{ "billed_charge": 5850.69, "npi": [1881785863] } ] } ] }, { "tin": { "type": "ein", "value": "550675666" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1020.12, "providers": [{ "billed_charge": 3400.07, "npi": [1073518007] } ] }, { "allowed_amount": 132466.38, "providers": [{ "billed_charge": 573062.81, "npi": [1073518007] } ] } ] }, { "tin": { "type": "ein", "value": "822577178" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21.12, "providers": [{ "billed_charge": 347.25, "npi": [1437813441] } ] } ] }, { "tin": { "type": "ein", "value": "310833936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.87, "providers": [{ "billed_charge": 2.38, "npi": [1548212988] } ] } ] }, { "tin": { "type": "ein", "value": "610676546" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 563.04, "providers": [{ "billed_charge": 1876.80, "npi": [1689761942] } ] } ] }, { "tin": { "type": "ein", "value": "621757921" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1617.86, "providers": [{ "billed_charge": 5392.80, "npi": [1326107319] } ] } ] }, { "tin": { "type": "ein", "value": "610724492" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16484.35, "providers": [{ "billed_charge": 55189.72, "npi": [1871547703] } ] } ] }, { "tin": { "type": "ein", "value": "611334601" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 91.69, "providers": [{ "billed_charge": 305.50, "npi": [1447457775] } ] }, { "allowed_amount": 433.51, "providers": [{ "billed_charge": 1444.75, "npi": [1679679146] } ] }, { "allowed_amount": 1951.27, "providers": [{ "billed_charge": 5850.25, "npi": [1992701429] } ] }, { "allowed_amount": 591.00, "providers": [{ "billed_charge": 1751.75, "npi": [1740488386] } ] }, { "allowed_amount": 17593.12, "providers": [{ "billed_charge": 98874.84, "npi": [1992701429] } ] }, { "allowed_amount": 81.85, "providers": [{ "billed_charge": 272.75, "npi": [1437150984] } ] }, { "allowed_amount": 68.56, "providers": [{ "billed_charge": 228.50, "npi": [1861650814] } ] } ] }, { "tin": { "type": "ein", "value": "610927491" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 106.62, "providers": [{ "billed_charge": 355.40, "npi": [1487643821] } ] } ] }, { "tin": { "type": "ein", "value": "610594620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 716.29, "providers": [{ "billed_charge": 2271.23, "npi": [1811922347] } ] } ] }, { "tin": { "type": "ein", "value": "610859329" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10933.82, "providers": [{ "billed_charge": 36445.18, "npi": [1427095488] } ] } ] }, { "tin": { "type": "ein", "value": "061705652" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 60.47, "providers": [{ "billed_charge": 201.57, "npi": [1407829567] } ] } ] } ] }, { "name": "HOSPICE/RTN HOME", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "651", "description": "HOSPICE SERVICES - ROUTINE HOME CARE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "310970252" }, "service_code": ["34"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29328.00, "providers": [{ "billed_charge": 41360.00, "npi": [1518926369] } ] } ] }, { "tin": { "type": "ein", "value": "610921718" }, "service_code": ["34"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1716.00, "providers": [{ "billed_charge": 2266.00, "npi": [1609922707] } ] } ] } ] }, { "name": "HOSPICE/NON-RESPITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "656", "description": "HOSPICE SERVICES - GENERAL INPATIENT CARE (NON-RESPITE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610921718" }, "service_code": ["34"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21080.25, "providers": [{ "billed_charge": 29092.17, "npi": [1609922707] } ] } ] } ] }, { "name": "EKG/ECG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "730", "description": "EKG/ECG - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "611334601" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2076.03, "providers": [{ "billed_charge": 4869.00, "npi": [1992701429] } ] } ] }, { "tin": { "type": "ein", "value": "611345363" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 461.34, "providers": [{ "billed_charge": 1094.00, "npi": [1871588772] } ] } ] }, { "tin": { "type": "ein", "value": "610859329" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 922.68, "providers": [{ "billed_charge": 1522.96, "npi": [1427095488] } ] } ] }, { "tin": { "type": "ein", "value": "610724492" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 722.08, "providers": [{ "billed_charge": 3595.04, "npi": [1871547703] } ] } ] } ] }, { "name": "DXA BONE DENSITY, AXIAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77080", "description": "DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "351153879" }, "service_code": ["19"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.50, "providers": [{ "billed_charge": 118.00, "npi": [1841618618] } ] } ] } ] }, { "name": "GUIDANCE FOR RADIAJ TX DLVR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77387", "description": "GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR DELIVERY OF RADIATION TREATMENT DELIVERY, INCLUDES IN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "863269008" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1364.00, "providers": [{ "billed_charge": 1364.00, "npi": [1184711954] } ] } ] } ] }, { "name": "METABOLIC PANEL TOTAL CA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1030.08, "providers": [{ "billed_charge": 2208.06, "npi": [1811154388] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80053", "description": "COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9621.78, "providers": [{ "billed_charge": 20623.68, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 380.99, "providers": [{ "billed_charge": 2011.06, "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": 9337.50, "providers": [{ "billed_charge": 20004.66, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 561.24, "providers": [{ "billed_charge": 2487.67, "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": 145.80, "providers": [{ "billed_charge": 312.48, "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": 800.80, "providers": [{ "billed_charge": 1715.70, "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": "262961334" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 118.85, "providers": [{ "billed_charge": 932.10, "npi": [1811883184] } ] } ] }, { "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4002.00, "providers": [{ "billed_charge": 8575.32, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "371874451" }, "service_code": ["57"], "billing_class": "professional", "payments": [{ "allowed_amount": 950.76, "providers": [{ "billed_charge": 3600.00, "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": 84.36, "providers": [{ "billed_charge": 180.69, "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": 3.15, "providers": [{ "billed_charge": 6.75, "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": 906.08, "providers": [{ "billed_charge": 1942.08, "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": 10898.72, "providers": [{ "billed_charge": 23354.40, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 851.54, "providers": [{ "billed_charge": 2664.00, "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": 319.48, "providers": [{ "billed_charge": 684.60, "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": 78.12, "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": 913.50, "providers": [{ "billed_charge": 1958.04, "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": 2976.51, "providers": [{ "billed_charge": 6378.84, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 276.81, "providers": [{ "billed_charge": 1660.12, "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": 312.96, "providers": [{ "billed_charge": 670.56, "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": 1202.04, "providers": [{ "billed_charge": 2576.07, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.46, "providers": [{ "billed_charge": 61.35, "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": 1564.08, "providers": [{ "billed_charge": 3351.60, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.29, "providers": [{ "billed_charge": 243.85, "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": 104.16, "providers": [{ "billed_charge": 223.20, "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": 208.08, "providers": [{ "billed_charge": 445.92, "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": 4240.08, "providers": [{ "billed_charge": 9088.56, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 317.93, "providers": [{ "billed_charge": 1564.02, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 679.50, "providers": [{ "billed_charge": 1455.75, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.31, "providers": [{ "billed_charge": 121.60, "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": 758.88, "providers": [{ "billed_charge": 1625.64, "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": 328.30, "providers": [{ "billed_charge": 703.50, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.11, "providers": [{ "billed_charge": 88.23, "npi": [1234567893] } ] } ] } ] }, { "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": 462.32, "providers": [{ "billed_charge": 990.72, "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": 5.14, "providers": [{ "billed_charge": 11.01, "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": 1228.42, "providers": [{ "billed_charge": 2632.62, "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": 1300.89, "providers": [{ "billed_charge": 2787.18, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.50, "providers": [{ "billed_charge": 421.80, "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": 9854.88, "providers": [{ "billed_charge": 21117.60, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 267.99, "providers": [{ "billed_charge": 1857.57, "npi": [1234567893] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 498.12, "providers": [{ "billed_charge": 1067.22, "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": 107.61, "providers": [{ "billed_charge": 230.52, "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": 4754.56, "providers": [{ "billed_charge": 10186.47, "npi": [1811154388] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 244.39, "providers": [{ "billed_charge": 1286.70, "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": 1576.44, "providers": [{ "billed_charge": 3377.34, "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": 114.19, "providers": [{ "billed_charge": 244.53, "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": [{ "allowed_amount": 170.10, "providers": [{ "billed_charge": 364.50, "npi": [1811154388] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86038", "description": "ANTINUCLEAR ANTIBODIES (ANA);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 152.37, "providers": [{ "billed_charge": 326.43, "npi": [1811154388] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-REACTIVE PROTEIN;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 543.75, "providers": [{ "billed_charge": 1165.50, "npi": [1811154388] } ] } ] } ] }, { "name": "T CELL, ABSOLUTE COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86361", "description": "T CELLS; ABSOLUTE CD4 COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 187.45, "providers": [{ "billed_charge": 401.70, "npi": [1811154388] } ] } ] } ] }, { "name": "TISS TRNSGLTMNASE EA IG CLAS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86364", "description": "TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.28, "providers": [{ "billed_charge": 69.18, "npi": [1811154388] } ] } ] } ] }, { "name": "RHEUMATOID FACTOR TEST QUAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86430", "description": "RHEUMATOID FACTOR; QUALITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.40, "providers": [{ "billed_charge": 73.68, "npi": [1811154388] } ] } ] } ] }, { "name": "TB AG RESPONSE T-CELL SUSP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86481", "description": "TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 280.00, "providers": [{ "billed_charge": 600.00, "npi": [1811154388] } ] } ] } ] }, { "name": "TREPONEMA PALLIDUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86780", "description": "ANTIBODY; TREPONEMA PALLIDUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 723.06, "providers": [{ "billed_charge": 1549.08, "npi": [1811154388] } ] } ] } ] }, { "name": "HEPATITIS C AB TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86803", "description": "HEPATITIS C ANTIBODY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.98, "providers": [{ "billed_charge": 42.81, "npi": [1811154388] } ] } ] } ] }, { "name": "CULTURE AEROBIC IDENTIFY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87077", "description": "CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 237.51, "providers": [{ "billed_charge": 509.04, "npi": [1811154388] } ] } ] } ] }, { "name": "URINE CULTURE/COLONY COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87086", "description": "CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 983.10, "providers": [{ "billed_charge": 2106.27, "npi": [1811154388] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE MIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87186", "description": "SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.88, "providers": [{ "billed_charge": 207.60, "npi": [1811154388] } ] } ] } ] }, { "name": "CHYLMD TRACH, DNA, AMP PROBE", "billing_code_type": "CPT", 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3255.00, "npi": [1821866401] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "205497203" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 185.36, "providers": [{ "billed_charge": 294.00, "npi": [1225332133] } ] } ] }, { "tin": { "type": "ein", "value": "465301590" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 896.87, "providers": [{ "billed_charge": 1625.00, "npi": [1467432682] } ] } ] } ] }, { "name": "PROLNG OFF/OP E/M EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99417", "description": "PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", 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"providers": [{ "billed_charge": 589.68, "npi": [1821635558] } ] } ] }, { "tin": { "type": "ein", "value": "320049006" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 145.13, "providers": [{ "billed_charge": 266.00, "npi": [1396791208] } ] } ] }, { "tin": { "type": "ein", "value": "610858140" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 247.18, "providers": [{ "billed_charge": 403.75, "npi": [1508823857] } ] } ] } ] }, { "name": "AMB SERVICE BLS EMERGENCY TR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "320049006" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 987.87, "providers": [{ "billed_charge": 1830.00, "npi": [1396791208] } ] } ] } ] }, { "name": 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"billing_code": "A7035", "description": "HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 987.08, "providers": [{ "billed_charge": 4749.65, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 780.31, "providers": [{ "billed_charge": 2499.04, "npi": [1234567893] } ] } ] } ] }, { "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", 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["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5540.05, "providers": [{ "billed_charge": 99303.20, "npi": [1234567893] } ] } ] } ] }, { "name": "O2 CONC 85%/>02 CONC PRSC FL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E1390", "description": "OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 594.00, "providers": [{ "billed_charge": 4321.91, "npi": [1234567893] } ] } ] } ] }, { "name": "PORTABLE OXYGEN CONCENTRATOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E1392", "description": "PORTABLE OXYGEN CONCENTRATOR, RENTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 45.91, "providers": [{ "billed_charge": 210.00, "npi": [1234567893] } ] } ] } ] }, { "name": "NEG PRSS WND TX PUMP STATN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E2402", "description": "NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10545.00, "providers": [{ "billed_charge": 32835.00, "npi": [1234567893] } ] } ] } ] }, { "name": "PROSTATE CANCER SCREENING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0103", "description": "PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1919.13, "providers": [{ "billed_charge": 4113.03, "npi": [1811154388] } ] } ] } ] }, { "name": "HIV ANTIGEN/ANTIBODY, COMBIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0475", "description": "HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610445850" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 370.81, "providers": [{ "billed_charge": 794.64, "npi": [1811154388] } ] } ] } ] }, { "name": "MED ASST TX METHADONE;WEEKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2067", "description": "MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "906244306" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 12858.30, "providers": [{ "billed_charge": 42861.00, "npi": [1336168251] } ] } ] }, { "tin": { "type": "ein", "value": "472519577" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 15810.23, "providers": [{ "billed_charge": 18870.00, "npi": [1659769446] } ] } ] } ] }, { "name": "MAT BUPRENORPHINE ORAL; WKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2068", "description": "MED ASST TX BUPRENORPHINE ORAL; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472519577" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 17235.00, "providers": [{ "billed_charge": 20685.00, "npi": [1659769446] } ] } ] } ] }, { "name": "MED ASST WKLY BUNDLE NOT INC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2074", "description": "MEDICATION ASSIST WEEKLY BUNDLE NOT INCL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472519577" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.53, "providers": [{ "billed_charge": 255.00, "npi": [1659769446] } ] } ] } ] }, { "name": "PA;PRD Q PERS DET APPR COMB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2077", "description": "PA;ASSESS PRD Q PERS DET MOST APPR COMB SRVC&TX", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472519577" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 9626.10, "providers": [{ "billed_charge": 11540.00, "npi": [1659769446] } ] } ] } ] }, { "name": "TH SUP METHADONE;TO 7 ADD D", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2078", "description": "TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "906244306" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 554.40, "providers": [{ "billed_charge": 1848.00, "npi": [1336168251] } ] } ] }, { "tin": { "type": "ein", "value": "472519577" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 977.02, "providers": [{ "billed_charge": 1210.00, "npi": [1659769446] } ] } ] } ] }, { "name": "TH SUP BPN ORAL;TO 7 ADD D S", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2079", "description": "TAKE HOME SUP BUPRENORPHINE ORAL;TO 7 ADD D SUP;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472519577" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 6687.45, "providers": [{ "billed_charge": 10500.00, "npi": [1659769446] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC;METHDONE ADM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0020", "description": "ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "364861811" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.25, "providers": [{ "billed_charge": 105.00, "npi": [1891789905] } ] } ] } ] }, { "name": "COMP CMTY SUPPRT SRV PER 15", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H2015", "description": "COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "610666065" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.55, "providers": [{ "billed_charge": 505.24, "npi": [1518652940] } ] } ] } ] }, { "name": "HIT IMPLANTED PUMP PAIN MGMT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9328", "description": "HOME INFUSION THERAPY, IMPLANTED PUMP PAIN MANAGEMENT INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13608.00, "providers": [{ "billed_charge": 45360.00, "npi": [1234567893] } ] } ] } ] } ] }