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"billing_class": "professional", "payments": [{ "allowed_amount": 776.16, "providers": [{ "billed_charge": 4656.96, "npi": [1306940689] } ] } ] }, { "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1399.20, "providers": [{ "billed_charge": 14045.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 710.20, "providers": [{ "billed_charge": 5618.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 542.70, "providers": [{ "billed_charge": 3253.77, "npi": [1306940689] } ] } ] } ] }, { "name": "ACUTE HEPATITIS PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80074", "description": "ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.10, "providers": [{ "billed_charge": 1185.00, "npi": [1740265347] } ] } ] } ] }, { "name": "DRUG TEST PRSMV DIR OPT OBS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80305", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834439721" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 100.80, "providers": [{ "billed_charge": 480.00, "npi": [1003256819] } ] } ] } ] }, { "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": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 683.54, "providers": [{ "billed_charge": 5018.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "475092976" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.64, "providers": [{ "billed_charge": 496.00, "npi": [1447973532] } ] } ] }, { "tin": { "type": "ein", "value": "634017243" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 186.42, "providers": [{ "billed_charge": 559.26, "npi": [1992718381] } ] } ] }, { "tin": { "type": "ein", "value": "843172409" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10377.38, "providers": [{ "billed_charge": 1402265.60, "npi": [1003437500] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": ["55", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19636.24, "providers": [{ "billed_charge": 2628560.80, "npi": [1508499393] } ] }, { "allowed_amount": 186.42, "providers": [{ "billed_charge": 25651.68, "npi": [1508499393] } ] } ] }, { "tin": { "type": "ein", "value": "823268636" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 807.82, "providers": [{ "billed_charge": 48750.00, "npi": [1457863391] } ] } ] }, { "tin": { "type": "ein", "value": "824323767" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.21, "providers": [{ "billed_charge": 11385.00, "npi": [1194201558] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5406.18, "providers": [{ "billed_charge": 21624.72, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "452215107" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11309.48, "providers": [{ "billed_charge": 67856.88, "npi": [1801226543] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3635.19, "providers": [{ "billed_charge": 385623.81, "npi": [1063011898] } ] } ] }, { "tin": { "type": "ein", "value": "814221217" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.07, "providers": [{ "billed_charge": 3998.40, "npi": [1134697196] } ] } ] }, { "tin": { "type": "ein", "value": "850612245" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 403.91, "providers": [{ "billed_charge": 2054.00, "npi": [1083830715] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.37, "providers": [{ "billed_charge": 1376.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.90, "providers": [{ "billed_charge": 370.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.56, "providers": [{ "billed_charge": 70.00, "npi": [1306940689] } ] } ] } ] }, { "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": "822567183" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16740.00, "providers": [{ "billed_charge": 85932.90, "npi": [1922518448] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 680.80, "providers": [{ "billed_charge": 5520.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.80, "providers": [{ "billed_charge": 5416.80, "npi": [1306940689] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.39, "providers": [{ "billed_charge": 693.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.36, "providers": [{ "billed_charge": 62.16, "npi": [1306940689] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.40, "providers": [{ "billed_charge": 740.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.86, "providers": [{ "billed_charge": 407.16, "npi": [1306940689] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.88, "providers": [{ "billed_charge": 335.28, "npi": [1306940689] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.30, "providers": [{ "billed_charge": 1290.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.05, "providers": [{ "billed_charge": 222.00, "npi": [1740265347] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.29, "providers": [{ "billed_charge": 55.56, "npi": [1306940689] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 578.34, "providers": [{ "billed_charge": 5712.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.46, "providers": [{ "billed_charge": 320.43, "npi": [1306940689] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.84, "providers": [{ "billed_charge": 528.00, "npi": [1740265347] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.75, "providers": [{ "billed_charge": 235.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.02, "providers": [{ "billed_charge": 138.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 261.58, "providers": [{ "billed_charge": 1569.48, "npi": [1306940689] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 445.20, "providers": [{ "billed_charge": 2671.20, "npi": [1306940689] } ] } ] }, { "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 890.40, "providers": [{ "billed_charge": 8904.00, "npi": [1740265347] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.08, "providers": [{ "billed_charge": 640.00, "npi": [1740265347] } ] } ] } ] }, { "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": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.41, "providers": [{ "billed_charge": 152.46, "npi": [1306940689] } ] } ] } ] }, { "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.45, "providers": [{ "billed_charge": 162.75, "npi": [1427827948] } ] } ] }, { "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.48, "providers": [{ "billed_charge": 8120.00, "npi": [1740265347] } ] } ] }, { "tin": { "type": "ein", "value": "731199725" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.13, "providers": [{ "billed_charge": 396.27, "npi": [1306940689] } ] } ] } ] }, { "name": "CCPD/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "851", "description": "CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203035983" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 52668.00, "providers": [{ "billed_charge": 808160.76, "npi": [1922049782] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.90, "providers": [{ "billed_charge": 378.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 38.85, "providers": [{ "billed_charge": 630.00, "npi": [1740265347] } ] } ] } ] }, { "name": "T CELLS, TOTAL COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86359", "description": "T CELLS; TOTAL COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 415.14, "providers": [{ "billed_charge": 4136.00, "npi": [1740265347] } ] } ] } ] }, { "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": "141841340" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 294.58, "providers": [{ "billed_charge": 4158.00, "npi": [1740265347] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86592", "description": "SYPHILIS TEST, NON-TREPONEMAL 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"providers": [{ "billed_charge": 212.82, "npi": [1234567893] } ] } ] } ] }, { "name": "WALKING BOOT, PNEUMATIC AND/", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "L4361", "description": "WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3548.10, "providers": [{ "billed_charge": 5695.68, "npi": [1234567893] } ] } ] } ] }, { "name": "TRAVL 1 WAY NEC LAB SPEC; TR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "P9604", "description": "TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843045583" }, "service_code": ["55", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 783.28, "providers": [{ "billed_charge": 1700.00, "npi": [1508499393] } ] }, { "allowed_amount": 23.05, "providers": [{ "billed_charge": 50.00, "npi": [1508499393] } ] } ] } ] }, { "name": "METHADONE ORAL 5MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S0109", "description": "METHADONE, ORAL, 5 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "736045246" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1892.11, "providers": [{ "billed_charge": 7139.60, "npi": [1235146036] } ] }, { "allowed_amount": 618.06, "providers": [{ "billed_charge": 4596.80, "npi": [1548304892] } ] } ] } ] }, { "name": "GLBAL FEE URGNT CARE CENTERS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9083", "description": "GLOBAL FEE URGENT CARE CENTERS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853756788" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1750.00, "providers": [{ "billed_charge": 7000.00, "npi": [1144541343] } ] } ] } ] }, { "name": "INTNSVE OP PSYC SVC PER DIEM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9480", "description": "INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823552173" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 74250.00, "providers": [{ "billed_charge": 297000.00, "npi": [1750149357] } ] } ] }, { "tin": { "type": "ein", "value": "932572939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 50212.50, "providers": [{ "billed_charge": 200850.00, "npi": [1790120483] } ] } ] }, { "tin": { "type": "ein", "value": "853005640" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 105873.25, "providers": [{ "billed_charge": 423493.00, "npi": [1396751533] } ] } ] } ] }, { "name": "HIT ANTIBIOTIC/ANTIFUNGAL; Q", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9500", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 24 HOURS; ADMINISTRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "991458508" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.50, "providers": [{ "billed_charge": 110.00, "npi": [1558507962] } ] }, { "allowed_amount": 587.50, "providers": [{ "billed_charge": 2350.00, "npi": [1558507962] } ] } ] } ] } ] }