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"allowed_amount": 5.02, "providers": [{ "billed_charge": 30.12, "npi": [1578778726] } ] }, { "allowed_amount": 18.78, "providers": [{ "billed_charge": 220.00, "npi": [1578778726] } ] }, { "allowed_amount": 16.06, "providers": [{ "billed_charge": 156.00, "npi": [1578778726] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 202.00, "npi": [1578778726] } ] }, { "allowed_amount": 3.20, "providers": [{ "billed_charge": 38.82, "npi": [1578778726] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 120.00, "npi": [1578778726] }, { "billed_charge": 31.80, "npi": [1578778726] } ] }, { "allowed_amount": 2.02, "providers": [{ "billed_charge": 24.00, "npi": [1578778726] } ] }, { "allowed_amount": 5.81, "providers": [{ "billed_charge": 71.00, "npi": [1578778726] } ] }, { "allowed_amount": 5.52, "providers": [{ "billed_charge": 27.60, "npi": [1578778726] } ] } ] }, { "tin": { "type": "ein", "value": "60646659" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.02, "providers": [{ "billed_charge": 52.00, "npi": [1609846088] } ] } ] } ] }, { "name": "ASSAY OF TROPONIN, QUANT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "TROPONIN, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "60646597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.09, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] } ] }, { "allowed_amount": 4.04, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] }, { "billed_charge": 32.00, "npi": [1548293343] } ] } ] }, { "tin": { "type": "ein", "value": "232825878" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.13, "providers": [{ "billed_charge": 712.00, "npi": [1962579029] } ] }, { "allowed_amount": 4.00, "providers": [{ "billed_charge": 1010.00, "npi": [1962579029] } ] }, { "allowed_amount": 2.02, "providers": [{ "billed_charge": 372.00, "npi": [1962579029] } ] } ] } ] }, { "name": "ASSAY OF GGT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "GLUTAMYLTRANSFERASE, GAMMA (GGT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "60646597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.09, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] } ] }, { "allowed_amount": 4.04, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] }, { "billed_charge": 32.00, "npi": [1548293343] } ] } ] }, { "tin": { "type": "ein", "value": "232825878" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.13, "providers": [{ "billed_charge": 712.00, "npi": [1962579029] } ] }, { "allowed_amount": 4.00, "providers": [{ "billed_charge": 1010.00, "npi": [1962579029] } ] }, { "allowed_amount": 2.02, "providers": [{ "billed_charge": 372.00, "npi": [1962579029] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "60646597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.09, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] } ] }, { "allowed_amount": 4.04, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] }, { "billed_charge": 32.00, "npi": [1548293343] } ] } ] }, { "tin": { "type": "ein", "value": "232825878" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.13, "providers": [{ "billed_charge": 712.00, "npi": [1962579029] } ] }, { "allowed_amount": 4.00, "providers": [{ "billed_charge": 1010.00, "npi": [1962579029] } ] }, { "allowed_amount": 2.02, "providers": [{ "billed_charge": 372.00, "npi": [1962579029] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID, CEREBROSPINAL FLUID)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "60646597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.09, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] } ] }, { "allowed_amount": 4.04, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] }, { "billed_charge": 32.00, "npi": [1548293343] } ] } ] }, { "tin": { "type": "ein", "value": "232825878" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.13, "providers": [{ "billed_charge": 712.00, "npi": [1962579029] } ] }, { "allowed_amount": 4.00, "providers": [{ "billed_charge": 1010.00, "npi": [1962579029] } ] }, { "allowed_amount": 2.02, "providers": [{ "billed_charge": 372.00, "npi": [1962579029] } ] } ] } ] }, { "name": "ASSAY OF CREATININE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "CREATININE; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "60646597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.09, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] } ] }, { "allowed_amount": 4.04, "providers": [{ "billed_charge": 23.00, "npi": [1548293343] }, { "billed_charge": 32.00, "npi": [1548293343] } ] } ] }, { "tin": { "type": "ein", "value": "232825878" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.13, "providers": [{ "billed_charge": 712.00, "npi": [1962579029] } ] }, { "allowed_amount": 4.00, "providers": [{ "billed_charge": 1010.00, "npi": [1962579029] } ] }, { "allowed_amount": 2.02, "providers": [{ "billed_charge": 372.00, "npi": [1962579029] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY OF CREATININE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "CREATININE; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY ALKALINE PHOSPHATASE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "PHOSPHATASE, ALKALINE;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY OF SERUM ALBUMIN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "CREATININE CLEARANCE TEST", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "CREATININE; CLEARANCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "GLUCOSE OTHER FLUID", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "GLUCOSE, BODY FLUID, OTHER THAN BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, 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1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY OF URINE/UREA-N", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "UREA NITROGEN, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, "providers": [{ "billed_charge": 171.42, "npi": [1497518591] } ] }, { "allowed_amount": 59.96, "providers": [{ "billed_charge": 4202.44, "npi": [1497518591] } ] }, { "allowed_amount": 43.56, "providers": [{ "billed_charge": 1733.20, "npi": [1497518591] } ] }, { "allowed_amount": 14.14, "providers": [{ "billed_charge": 826.10, "npi": [1497518591] } ] }, { "allowed_amount": 16.26, "providers": [{ "billed_charge": 678.54, "npi": [1497518591] }, { "billed_charge": 878.58, "npi": [1497518591] } ] }, { "allowed_amount": 54.51, "providers": [{ "billed_charge": 2240.94, "npi": [1497518591] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 900.76, "npi": [1497518591] }, { "billed_charge": 904.72, "npi": [1497518591] } ] }, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", 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}, { "allowed_amount": 23.38, "providers": [{ "billed_charge": 1132.28, "npi": [1497518591] } ] }, { "allowed_amount": 5.08, "providers": [{ "billed_charge": 207.75, "npi": [1497518591] }, { "billed_charge": 223.61, "npi": [1497518591] } ] }, { "allowed_amount": 13.37, "providers": [{ "billed_charge": 514.74, "npi": [1497518591] } ] }, { "allowed_amount": 11.18, "providers": [{ "billed_charge": 463.08, "npi": [1497518591] }, { "billed_charge": 451.60, "npi": [1497518591] } ] }, { "allowed_amount": 41.72, "providers": [{ "billed_charge": 1660.00, "npi": [1497518591] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463938699" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.29, "providers": [{ "billed_charge": 1763.74, "npi": [1497518591] } ] }, { "allowed_amount": 3.93, 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31160.00, "providers": [{ "billed_charge": 56000.00, "npi": [1144248071] } ] } ] }, { "tin": { "type": "ein", "value": "264363837" }, "service_code": ["11", "24"], "billing_class": "professional", "payments": [{ "allowed_amount": 1800.00, "providers": [{ "billed_charge": 82800.00, "npi": [1306880547] } ] }, { "allowed_amount": 1140.00, "providers": [{ "billed_charge": 53400.00, "npi": [1306880547] } ] }, { "allowed_amount": 896.00, "providers": [{ "billed_charge": 43200.00, "npi": [1598744161] } ] } ] }, { "tin": { "type": "ein", "value": "843159441" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 516.00, "providers": [{ "billed_charge": 33312.09, "npi": [1922751254] } ] } ] }, { "tin": { "type": "ein", "value": "202829616" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 264.00, "providers": [{ "billed_charge": 2520.00, "npi": [1821193889] } ] } ] }, { "tin": { "type": "ein", "value": "262487820" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 662.00, "providers": [{ "billed_charge": 35425.00, "npi": [1952644429] } ] } ] }, { "tin": { "type": "ein", "value": "273478440" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2672.00, "providers": [{ "billed_charge": 70600.00, "npi": [1982653622] } ] } ] }, { "tin": { "type": "ein", "value": "473625728" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 31710.00, "providers": [{ "billed_charge": 125988.37, "npi": [1063455590] } ] }, { "allowed_amount": 30353.00, "providers": [{ "billed_charge": 163744.77, "npi": [1972526671] } ] }, { "allowed_amount": 10328.00, "providers": [{ "billed_charge": 48475.03, "npi": [1851570303] } ] } ] }, { "tin": { "type": "ein", "value": "473696105" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2160.00, "providers": [{ "billed_charge": 222000.00, "npi": [1811383300] } ] } ] }, { "tin": { "type": "ein", "value": "272857609" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 984.00, "providers": [{ "billed_charge": 16800.00, "npi": [1750365110] } ] } ] }, { "tin": { "type": "ein", "value": "821243243" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15701.00, "providers": [{ "billed_charge": 147326.67, "npi": [1598294266] } ] } ] }, { "tin": { "type": "ein", "value": "271357264" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1990.00, "providers": [{ "billed_charge": 69600.00, "npi": [1629051230] } ] } ] }, { "tin": { "type": "ein", "value": "273106454" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4300.00, "providers": [{ "billed_charge": 9600.00, "npi": [1477710341] } ] } ] } ] }, { "name": "ANES LWR INTST SCR COLSC", "billing_code_type": "CPT", "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": "861908119" }, "service_code": ["22", "24", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 444.00, "providers": [{ "billed_charge": 20250.00, "npi": [1619633898] } ] }, { "allowed_amount": 493.00, "providers": [{ "billed_charge": 34650.00, "npi": [1619633898] } ] }, { "allowed_amount": 240.00, "providers": [{ "billed_charge": 10800.00, "npi": [1619633898] } ] } ] }, { "tin": { "type": "ein", "value": "204996308" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2854.00, "providers": [{ "billed_charge": 79000.00, "npi": [1053351973] } ] } ] }, { "tin": { "type": "ein", "value": "821143618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 60.00, "providers": [{ "billed_charge": 2800.00, "npi": [1891757274] } ] } ] }, { "tin": { "type": "ein", "value": "843159441" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2062.00, "providers": [{ "billed_charge": 143401.35, "npi": [1922751254] } ] } ] }, { "tin": { "type": "ein", "value": "133901519" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 830.00, "providers": [{ "billed_charge": 427000.00, "npi": [1851353270] } ] } ] }, { "tin": { "type": "ein", "value": "800797091" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 300.00, "providers": [{ "billed_charge": 6800.00, "npi": [1871869305] } ] } ] }, { "tin": { "type": "ein", "value": "814504190" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 60.00, "providers": [{ "billed_charge": 6960.00, "npi": [1891235404] } ] } ] }, { "tin": { "type": "ein", "value": "862251102" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.00, "providers": [{ "billed_charge": 2825.00, "npi": [1366016677] } ] } ] }, { "tin": { "type": "ein", "value": "474035304" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 60.00, "providers": [{ "billed_charge": 3433.75, "npi": [1790985596] } ] } ] }, { "tin": { "type": "ein", "value": "273106454" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3316.00, "providers": [{ "billed_charge": 8000.00, "npi": [1477710341] } ] } ] } ] }, { "name": "ANES UPR LWR GI NDSC PX", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "813", "description": "ANESTHESIA FOR COMBINED UPPER AND LOWER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800797091" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 788.00, "providers": [{ "billed_charge": 14000.00, "npi": [1871869305] } ] } ] }, { "tin": { "type": "ein", "value": "202829616" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 156.00, "providers": [{ "billed_charge": 1260.00, "npi": [1821193889] } ] } ] } ] }, { "name": "HEMODIALYSIS ONE EVALUATION", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS PROCEDURE WITH SINGLE EVALUATION BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "862871674" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1300.00, "providers": [{ "billed_charge": 45552.84, "npi": [1891437281] } ] }, { "allowed_amount": 2600.00, "providers": [{ "billed_charge": 91105.68, "npi": [1891437281] } ] } ] } ] }, { "name": "DIALYSIS PROCEDURE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "862871674" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1300.00, "providers": [{ "billed_charge": 45552.84, "npi": [1891437281] } ] }, { "allowed_amount": 2600.00, "providers": [{ "billed_charge": 91105.68, "npi": [1891437281] } ] } ] } ] }, { "name": "ASSAY TEST FOR BLOOD, FECAL", "billing_code_type": "CPT", "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": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.80, "providers": [{ "billed_charge": 517.40, "npi": [1013905074] } ] } ] } ] }, { "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": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 213.12, "providers": [{ "billed_charge": 420.00, "npi": [1255409553] } ] } ] } ] }, { "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": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.96, "providers": [{ "billed_charge": 270.00, "npi": [1255409553] } ] } ] } ] }, { "name": "PANCREATIC ELASTASE, FECAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82656", "description": "ELASTASE, PANCREATIC (EL-1), FECAL, QUALITATIVE OR SEMI-QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 76.65, "providers": [{ "billed_charge": 390.00, "npi": [1013905074] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.36, "providers": [{ "billed_charge": 45.00, "npi": [1255409553] } ] } ] } ] }, { "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": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 45.48, "providers": [{ "billed_charge": 96.00, "npi": [1255409553] } ] } ] } ] }, { "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": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 130.08, "providers": [{ "billed_charge": 240.00, "npi": [1255409553] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 133.32, "providers": [{ "billed_charge": 240.00, "npi": [1255409553] } ] } ] } ] }, { "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": "843016042" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.30, "providers": [{ "billed_charge": 320.00, "npi": [1598315574] } ] } ] }, { "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.65, "providers": [{ "billed_charge": 30.00, "npi": [1518051820] } ] }, { "allowed_amount": 229.12, "providers": [{ "billed_charge": 600.00, "npi": [1255409553] } ] }, { "allowed_amount": 104.85, "providers": [{ "billed_charge": 270.00, "npi": [1699838870] } ] } ] } ] }, { "name": "ASSAY OF INSULIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83525", "description": "INSULIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.16, "providers": [{ "billed_charge": 90.00, "npi": [1255409553] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943357013" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.80, "providers": [{ "billed_charge": 936.00, "npi": [1982606992] } ] } ] }, { "tin": { "type": "ein", "value": "843016042" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.20, "providers": [{ "billed_charge": 150.00, "npi": [1598315574] } ] } ] }, { "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.60, "providers": [{ "billed_charge": 90.00, "npi": [1255409553] } ] } ] } ] }, { "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": "843016042" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.10, "providers": [{ "billed_charge": 81.00, "npi": [1598315574] } ] } ] }, { "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.58, "providers": [{ "billed_charge": 120.00, "npi": [1255409553] } ] } ] } ] }, { "name": "LACTOFERRIN, FECAL (QUANT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83631", "description": "LACTOFERRIN, FECAL; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 127.58, "providers": [{ "billed_charge": 490.70, "npi": [1013905074] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.30, "providers": [{ "billed_charge": 210.00, "npi": [1518051820] } ] }, { "allowed_amount": 122.00, "providers": [{ "billed_charge": 300.00, "npi": [1255409553] } ] }, { "allowed_amount": 24.40, "providers": [{ "billed_charge": 60.00, "npi": [1699838870] } ] } ] } ] }, { "name": "ASSAY FOR CALPROTECTIN FECAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83993", "description": "CALPROTECTIN, FECAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.69, "providers": [{ "billed_charge": 1078.00, "npi": [1013905074] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943357013" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.49, "providers": [{ "billed_charge": 342.00, "npi": [1982606992] } ] } ] } ] }, { "name": "ASSAY OF TOTAL THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84436", "description": "THYROXINE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 117.47, "providers": [{ "billed_charge": 340.00, "npi": [1699838870] } ] }, { "allowed_amount": 205.00, "providers": [{ "billed_charge": 600.00, "npi": [1255409553] } ] } ] } ] }, { "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": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.60, "providers": [{ "billed_charge": 500.00, "npi": [1518051820] } ] } ] } ] }, { "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": "843016042" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.82, "providers": [{ "billed_charge": 344.00, "npi": [1598315574] } ] } ] }, { "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 312.74, "providers": [{ "billed_charge": 1350.00, "npi": [1518051820] } ] }, { "allowed_amount": 194.56, "providers": [{ "billed_charge": 810.00, "npi": [1699838870] } ] }, { "allowed_amount": 400.03, "providers": [{ "billed_charge": 1665.00, "npi": [1255409553] } ] } ] } ] }, { "name": "ASSAY OF THYROID (T3 OR T4)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84479", "description": "THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133457651" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.00, "providers": [{ "billed_charge": 360.00, "npi": [1699838870] } ] }, { "allowed_amount": 104.00, "providers": [{ "billed_charge": 520.00, "npi": [1255409553] } ] } ] } ] }, { "name": "ASSAY, TRIIODOTHYRONINE (T3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84480", "description": 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