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[{ "billed_charge": 139.94, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 235.76, "providers": [{ "billed_charge": 88.94, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 927.95, "providers": [{ "billed_charge": 296.00, "npi": [1316984388] } ] }, { "allowed_amount": 714.21, "providers": [{ "billed_charge": 193.00, "npi": [1316984388] } ] }, { "allowed_amount": 2118.24, "providers": [{ "billed_charge": 1626.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37264.27, "providers": [{ "billed_charge": 10681.44, "npi": [1720279805] } ] }, { "allowed_amount": 2210.13, "providers": [{ "billed_charge": 850.08, "npi": [1578549044] } ] }, { "allowed_amount": 652.96, "providers": [{ "billed_charge": 406.56, "npi": [1861018574] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 954.00, "providers": [{ "billed_charge": 187.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2333.91, "providers": [{ "billed_charge": 2306.08, "npi": [1356409379] } ] }, { "allowed_amount": 8884.39, "providers": [{ "billed_charge": 2964.96, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7939.53, "providers": [{ "billed_charge": 2925.96, "npi": [1942257191] } ] }, { "allowed_amount": 522.82, "providers": [{ "billed_charge": 768.02, "npi": [1942257191] } ] }, { "allowed_amount": 498.81, "providers": [{ "billed_charge": 545.60, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "841433257" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1346.70, "providers": [{ "billed_charge": 113.00, "npi": [1710941158] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.92, "providers": [{ "billed_charge": 201.50, "npi": [1932145778] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80061", "description": "LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2367.02, "providers": [{ "billed_charge": 492.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 191.01, "providers": [{ "billed_charge": 76.92, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 145577.42, "providers": [{ "billed_charge": 30652.98, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1459.41, "providers": [{ "billed_charge": 1523.99, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 968.88, "providers": [{ "billed_charge": 1355.44, "npi": [1932145778] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80069", "description": "RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3289.66, "providers": [{ "billed_charge": 1213.02, "npi": [1356409379] } ] }, { "allowed_amount": 116.80, "providers": [{ "billed_charge": 134.78, "npi": [1356409379] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80076", "description": "HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2365.82, "providers": [{ "billed_charge": 686.40, "npi": [1720279805] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80307", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.93, "providers": [{ "billed_charge": 345.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1981.05, "providers": [{ "billed_charge": 575.98, "npi": [1730119553] } ] }, { "allowed_amount": 2093.50, "providers": [{ "billed_charge": 657.80, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2767.20, "providers": [{ "billed_charge": 490.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "843172409" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24721.79, "providers": [{ "billed_charge": 58777.60, "npi": [1003437500] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34228.64, "providers": [{ "billed_charge": 42752.80, "npi": [1508499393] } ] } ] }, { "tin": { "type": "ein", "value": "452215107" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4287.66, "providers": [{ "billed_charge": 4287.66, "npi": [1801226543] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 62941.44, "providers": [{ "billed_charge": 105469.76, "npi": [1063011898] } ] } ] }, { "tin": { "type": "ein", "value": "271804269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2472.82, "providers": [{ "billed_charge": 2480.00, "npi": [1699085290] } ] } ] }, { "tin": { "type": "ein", "value": "842833120" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 587.46, "providers": [{ "billed_charge": 497.12, "npi": [1104466994] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2044.15, "providers": [{ "billed_charge": 59.54, "npi": [1730119553] } ] }, { "allowed_amount": 388.80, "providers": [{ "billed_charge": 28.58, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 668.62, "providers": [{ "billed_charge": 150.00, "npi": [1174113534] } ] }, { "allowed_amount": 18.00, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31770.50, "providers": [{ "billed_charge": 2117.52, "npi": [1720279805] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81003", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.20, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6875.78, "providers": [{ "billed_charge": 342.65, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.08, "providers": [{ "billed_charge": 16.84, "npi": [1356409379] } ] }, { "allowed_amount": 137.93, "providers": [{ "billed_charge": 16.84, "npi": [1356409379] } ] } ] } ] }, { "name": "ANES LWR INTST SCR COLSC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "812", "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; SCRE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834708723" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 5683.06, "providers": [{ "billed_charge": 8250.00, "npi": [1487214698] } ] } ] } ] }, { "name": "NFCT DS BV RNA VAG FLU ALG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81513", "description": "NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25641.80, "providers": [{ "billed_charge": 34445.49, "npi": [1720279805] } ] } ] } ] }, { "name": "MICROALBUMIN, QUANTITATIVE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82043", "description": "ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20082.17, "providers": [{ "billed_charge": 3028.20, "npi": [1720279805] } ] } ] } ] }, { "name": "HEMO/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2677941.83, "providers": [{ "billed_charge": 328200.60, "npi": [1124682166] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8730028.32, "providers": [{ "billed_charge": 421363.77, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "932053086" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2102757.49, "providers": [{ "billed_charge": 215728.11, "npi": [1538845474] } ] } ] }, { "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 613800.00, "providers": [{ "billed_charge": 78000.00, "npi": [] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 561404.03, "providers": [{ "billed_charge": 91799.18, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "232741218" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2604401.73, "providers": [{ "billed_charge": 161190.00, "npi": [1013978469] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2749609.40, "providers": [{ "billed_charge": 197010.00, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "770462755" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2302960.00, "providers": [{ "billed_charge": 182000.00, "npi": [] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3866097.51, "providers": [{ "billed_charge": 256128.00, "npi": [1386180859] } ] } ] }, { "tin": { "type": "ein", "value": "260689726" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2862755.89, "providers": [{ "billed_charge": 202980.00, "npi": [1427242080] } ] } ] }, { "tin": { "type": "ein", "value": "814657391" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2390533.82, "providers": [{ "billed_charge": 91105.68, "npi": [1790229318] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 704214.00, "providers": [{ "billed_charge": 264960.00, "npi": [1609217157] } ] } ] } ] }, { "name": "ASSAY OF APOLIPOPROTEIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82172", "description": "APOLIPOPROTEIN, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3677.92, "providers": [{ "billed_charge": 812.02, "npi": [1720279805] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4435.63, "providers": [{ "billed_charge": 298.69, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY TEST FOR BLOOD, FECAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82274", "description": "BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 611.12, "providers": [{ "billed_charge": 668.64, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 98629.82, "providers": [{ "billed_charge": 33877.20, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF CALCIUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82330", "description": "CALCIUM; IONIZED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5824.84, "providers": [{ "billed_charge": 1521.10, "npi": [1942257191] } ] } ] } ] }, { "name": "COL CHROMOTOGRAPHY QUAL/QUAN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82542", "description": "COLUMN CHROMATOGRAPHY, INCLUDES MASS SPECTROMETRY, IF PERFORMED (EG, HPLC, LC, LC/MS, LC/MS-MS, GC,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271117058" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 399.86, "providers": [{ "billed_charge": 319.01, "npi": [1063734739] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24936.05, "providers": [{ "billed_charge": 2030.56, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34662.95, "providers": [{ "billed_charge": 5436.34, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8833.32, "providers": [{ "billed_charge": 2738.12, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37499.47, "providers": [{ "billed_charge": 6679.40, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8400.65, "providers": [{ "billed_charge": 1183.35, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 633.90, "providers": [{ "billed_charge": 292.95, "npi": [1720279805] } ] } ] } ] }, { "name": "BLOOD GASES ANY COMBINATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82803", "description": "GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO3 (INCLUDING CALCULATED O2 SATURATION);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1056.77, "providers": [{ "billed_charge": 1132.50, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4527.01, "providers": [{ "billed_charge": 1797.00, "npi": [1356409379] } ] }, { "allowed_amount": 15.09, "providers": [{ "billed_charge": 59.90, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 622.39, "providers": [{ "billed_charge": 209.88, "npi": [1942257191] } ] } ] } ] }, { "name": "REAGENT STRIP/BLOOD GLUCOSE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82948", "description": "GLUCOSE; BLOOD, REAGENT STRIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3329.46, "providers": [{ "billed_charge": 139.92, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7294.80, "providers": [{ "billed_charge": 2371.38, "npi": [1568431088] } ] }, { "allowed_amount": 6.64, "providers": [{ "billed_charge": 143.72, "npi": [1568431088] } ] } ] } ] }, { "name": "GLUCOSE TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82950", "description": "GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 378.55, "providers": [{ "billed_charge": 128.38, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9241.09, "providers": [{ "billed_charge": 2276.05, "npi": [1720279805] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 239.70, "providers": [{ "billed_charge": 107.64, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 432.34, "providers": [{ "billed_charge": 90.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 123707.47, "providers": [{ "billed_charge": 17844.75, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1913.57, "providers": [{ "billed_charge": 764.55, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 65.93, "providers": [{ "billed_charge": 84.95, "npi": [1932145778] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35257.74, "providers": [{ "billed_charge": 2967.15, "npi": [1720279805] } ] } ] } ] }, { "name": "LACTATE (LD) (LDH) ENZYME", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83615", "description": "LACTATE DEHYDROGENASE (LD), (LDH);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4334.70, "providers": [{ "billed_charge": 655.20, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1800.43, "providers": [{ "billed_charge": 349.83, "npi": [1730119553] } ] }, { "allowed_amount": 439.06, "providers": [{ "billed_charge": 116.61, "npi": [1730119553] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN(A)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83695", "description": "LIPOPROTEIN (A)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4462.45, "providers": [{ "billed_charge": 1052.52, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 366.25, "providers": [{ "billed_charge": 162.60, "npi": [1730119553] } ] }, { "allowed_amount": 16514.56, "providers": [{ "billed_charge": 3450.00, "npi": [1730119553] } ] }, { "allowed_amount": 166.20, "providers": [{ "billed_charge": 73.25, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 943.20, "providers": [{ "billed_charge": 174.00, "npi": [1174113534] } ] }, { "allowed_amount": 2185.40, "providers": [{ "billed_charge": 180.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1924.53, "providers": [{ "billed_charge": 164.15, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 522.22, "providers": [{ "billed_charge": 262.05, "npi": [1356409379] } ] }, { "allowed_amount": 11291.27, "providers": [{ "billed_charge": 2358.45, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12425.87, "providers": [{ "billed_charge": 732.12, "npi": [1942257191] } ] }, { "allowed_amount": 243.79, "providers": [{ "billed_charge": 91.44, "npi": [1942257191] } ] }, { "allowed_amount": 169.66, "providers": [{ "billed_charge": 22.86, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3267.02, "providers": [{ "billed_charge": 1733.76, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5603.89, "providers": [{ "billed_charge": 164.40, "npi": [1730119553] } ] }, { "allowed_amount": 137.01, "providers": [{ "billed_charge": 26.79, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4213.06, "providers": [{ "billed_charge": 599.04, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12498.70, "providers": [{ "billed_charge": 344.32, "npi": [1942257191] } ] }, { "allowed_amount": 27.10, "providers": [{ "billed_charge": 21.52, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24649.24, "providers": [{ "billed_charge": 6837.31, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1687.19, "providers": [{ "billed_charge": 100.94, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3412.61, "providers": [{ "billed_charge": 1180.42, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 38234.66, "providers": [{ "billed_charge": 4798.64, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17636.84, "providers": [{ "billed_charge": 6585.60, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34205.86, "providers": [{ "billed_charge": 5850.46, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY, TRIIODOTHYRONINE (T3)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84480", "description": "TRIIODOTHYRONINE T3; TOTAL (TT-3)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1294.04, "providers": [{ "billed_charge": 99.26, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TROPONIN, QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84484", "description": "TROPONIN, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1097.59, "providers": [{ "billed_charge": 228.69, "npi": [1730119553] } ] }, { "allowed_amount": 144.04, "providers": [{ "billed_charge": 25.41, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 699.80, "providers": [{ "billed_charge": 210.00, "npi": [1174113534] } ] }, { "allowed_amount": 887.20, "providers": [{ "billed_charge": 336.00, "npi": [1174113534] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1563.90, "providers": [{ "billed_charge": 142.38, "npi": [1720279805] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 724.85, "providers": [{ "billed_charge": 263.40, "npi": [1720279805] } ] } ] } ] }, { "name": "BL SMEAR W/DIFF WBC COUNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85007", "description": "BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3220.87, "providers": [{ "billed_charge": 314.40, "npi": [1356409379] } ] }, { "allowed_amount": 280.56, "providers": [{ "billed_charge": 52.40, "npi": [1356409379] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "HCPCS", "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": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 808.71, "providers": [{ "billed_charge": 228.88, "npi": [1730119553] } ] }, { "allowed_amount": 24003.61, "providers": [{ "billed_charge": 2035.76, "npi": [1730119553] } ] }, { "allowed_amount": 2622.22, "providers": [{ "billed_charge": 389.92, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1723.55, "providers": [{ "billed_charge": 302.65, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 148.96, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] }, { "allowed_amount": 6541.40, "providers": [{ "billed_charge": 1290.00, "npi": [1174113534] } ] }, { "allowed_amount": 6201.15, 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"billed_charge": 566.00, "npi": [1316984388] } ] }, { "allowed_amount": 2097.51, "providers": [{ "billed_charge": 1376.00, "npi": [1316984388] } ] }, { "allowed_amount": 209.00, "providers": [{ "billed_charge": 190.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1971.48, "providers": [{ "billed_charge": 344.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 64.19, "providers": [{ "billed_charge": 59.90, "npi": [1356409379] } ] }, { "allowed_amount": 9509.33, "providers": [{ "billed_charge": 2695.50, "npi": [1356409379] } ] }, { "allowed_amount": 2701.72, "providers": [{ "billed_charge": 2096.50, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": 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"billing_class": "professional", "payments": [{ "allowed_amount": 81541.82, "providers": [{ "billed_charge": 94265.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "330516944" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4944.84, "providers": [{ "billed_charge": 5448.00, "npi": [1619923653] } ] } ] }, { "tin": { "type": "ein", "value": "462690851" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 22815.48, "providers": [{ "billed_charge": 27698.00, "npi": [1710315353] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4875.30, "providers": [{ "billed_charge": 5417.00, "npi": [1447288345] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 19838.75, "providers": [{ "billed_charge": 22450.00, "npi": [1104889138] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 18248.00, "providers": [{ "billed_charge": 18288.00, "npi": [1861432627] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 15450.63, "providers": [{ "billed_charge": 18004.00, "npi": [1477508984] } ] }, { "allowed_amount": 20787.07, "providers": [{ "billed_charge": 23148.00, "npi": [1881632149] } ] }, { "allowed_amount": 25715.69, "providers": [{ "billed_charge": 29578.00, "npi": [1780625871] } ] }, { "allowed_amount": 2031.88, "providers": [{ "billed_charge": 2572.00, "npi": [1710686035] } ] }, { "allowed_amount": 56351.75, "providers": [{ "billed_charge": 64300.00, "npi": [1326346438] } ] }, { "allowed_amount": 9762.44, "providers": [{ "billed_charge": 11574.00, "npi": [1346265154] } ] }, { "allowed_amount": 5128.00, "providers": [{ "billed_charge": 5144.00, "npi": [1407886138] } ] }, { "allowed_amount": 14952.44, "providers": [{ "billed_charge": 18004.00, "npi": [1578720124] } ] } ] }, { "tin": { "type": "ein", "value": "943278555" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1215.00, "providers": [{ "billed_charge": 1215.00, "npi": [1134110661] } ] } ] }, { "tin": { "type": "ein", "value": "953192932" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2865.00, "providers": [{ "billed_charge": 3330.00, "npi": [1871535286] } ] } ] }, { "tin": { "type": "ein", "value": "953056292" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8434.65, "providers": [{ "billed_charge": 12915.00, "npi": [1740214733] } ] } ] }, { "tin": { "type": "ein", "value": "274096788" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 10621.60, "providers": [{ "billed_charge": 17338.68, "npi": [1972953230] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99307", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460761426" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 92.66, "providers": [{ "billed_charge": 280.00, "npi": [1912665027] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99308", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853351517" }, "service_code": ["31", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 906.46, "providers": [{ "billed_charge": 1500.00, "npi": [1356944235] } ] }, { "allowed_amount": 1381.26, "providers": [{ "billed_charge": 2100.00, "npi": [1356944235] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99309", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821938082" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 722.87, "providers": [{ "billed_charge": 840.00, "npi": [1497265565] } ] } ] }, { "tin": { "type": "ein", "value": "464114201" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 768.16, "providers": [{ "billed_charge": 2028.00, "npi": [1023449741] } ] } ] }, { "tin": { "type": "ein", "value": "854274948" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1080.90, "providers": [{ "billed_charge": 554.36, "npi": [1003407735] } ] } ] }, { "tin": { "type": "ein", "value": "208748539" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 3268.55, "providers": [{ "billed_charge": 2970.00, "npi": [1720261506] } ] } ] }, { "tin": { "type": "ein", "value": "853351517" }, "service_code": ["31", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 404.26, "providers": [{ "billed_charge": 600.00, "npi": [1356944235] } ] } ] } ] }, { "name": "PROLNG OFF/OP E/M EA 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99417", "description": "PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273081619" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6450.60, "providers": [{ "billed_charge": 1600.00, "npi": [1912362567] } ] } ] }, { "tin": { "type": "ein", "value": "923084561" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 869.78, "providers": [{ "billed_charge": 768.00, "npi": [1649975681] } ] } ] }, { "tin": { "type": "ein", "value": "990998900" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1270.00, "providers": [{ "billed_charge": 2673.00, "npi": [1780435529] } ] } ] }, { "tin": { "type": "ein", "value": "991764996" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8423.07, "providers": [{ "billed_charge": 9726.79, "npi": [1972354371] } ] } ] } ] }, { "name": "NEONATE CRIT CARE SUBSQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99469", "description": "SUBSEQUENT INPATIENT NEONATAL CRITICAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A CRITICA", "allowed_amounts": [{ "tin": { "type": "ein", "value": 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"professional", "payments": [{ "allowed_amount": 1417.20, "providers": [{ "billed_charge": 410.33, "npi": [1477222834] } ] } ] } ] }, { "name": "ADAPTER FOR BREAST PUMP REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4282", "description": "ADAPTER FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1528.00, "providers": [{ "billed_charge": 425.68, "npi": [1477222834] } ] } ] } ] }, { "name": "CAP BRST PUMP BOTLE REPLCMNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4283", "description": "CAP FOR BREAST PUMP BOTTLE, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1397.10, "providers": [{ "billed_charge": 97.75, "npi": [1477222834] } ] } ] } ] }, { "name": "BRST SHIELD&SPLSH PROTCTR PU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4284", "description": "BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1527.20, "providers": [{ "billed_charge": 168.91, "npi": [1477222834] } ] } ] } ] }, { "name": "POLYCARBATE BOTTLE BRST PUMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4285", "description": "POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1202.04, "providers": [{ "billed_charge": 148.59, "npi": [1477222834] } ] } ] } ] }, { "name": "LOCKING RING BRST PUMP REPLC", "billing_code_type": "HCPCS", 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"billing_code": "A4556", "description": "ELECTRODES (E.G., APNEA MONITOR), PER PAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7388.49, "providers": [{ "billed_charge": 11533.50, "npi": [1770511552] } ] } ] } ] }, { "name": "ELEC STIM SPPLS 2 LD PER MTH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4595", "description": "ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G., TENS, NMES)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 41180.34, "providers": [{ "billed_charge": 51225.30, "npi": [1770511552] } ] } ] } ] }, { "name": "TUBING W/INTGR HEAT ELEM W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4604", "description": "TUBING WITH INTEGRATED HEATING ELEMENT FOR USE 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"tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8165.35, "providers": [{ "billed_charge": 1826.37, "npi": [1770511552] } ] } ] } ] }, { "name": "FULL FCE MASK POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7030", "description": "FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1154.44, "providers": [{ "billed_charge": 1088.93, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 775.92, "providers": [{ "billed_charge": 327.36, "npi": [1477222834] } ] } ] } ] }, { "name": "FCE MASK INTERFCE REPL FULL", "billing_code_type": "HCPCS", 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1288.00, "npi": [1932121514] } ] } ] } ] }, { "name": "ENTERAL FEED SPL KIT; PUMP F", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "B4035", "description": "ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "314379441" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7246.92, "providers": [{ "billed_charge": 228.00, "npi": [1275198780] } ] } ] } ] }, { "name": "OCCLUSAL ORTHOTIC APPLIANCE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "D7880", "description": "OCCLUSAL ORTHOTIC APPLIANCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680177804" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2000.00, "providers": [{ "billed_charge": 6000.00, "npi": [1346393105] } ] } ] } ] }, { "name": "PRTBLE GASEOUS O2 SYS 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"billing_class": "professional", "payments": [{ "allowed_amount": 2233.19, "providers": [{ "billed_charge": 843.74, "npi": [1477222834] } ] } ] } ] }, { "name": "CONTINUOUS POS AIRWAY PRESSU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0601", "description": "CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9824.18, "providers": [{ "billed_charge": 9938.96, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4226.97, "providers": [{ "billed_charge": 2521.42, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3812.40, "providers": [{ "billed_charge": 3475.00, "npi": [1144767542] } ] } ] } ] }, { "name": "BREAST PUMP ELECTRIC ANY TYP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0603", "description": "BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10315.80, "providers": [{ "billed_charge": 9636.00, "npi": [1477222834] } ] } ] } ] }, { "name": "TENS DEVICE 4/> LEADS MX NER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0730", "description": "TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, 4 OR MORE LEADS, FOR MULTIPLE NERVE STIMU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 12638.25, "providers": [{ "billed_charge": 16974.00, "npi": [1770511552] } ] } ] } ] }, { "name": 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"value": "814484151" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23155.30, "providers": [{ "billed_charge": 1824.00, "npi": [1093240285] } ] } ] } ] }, { "name": "INTRA-F LOC&TRCK TRGT/PT M E", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G6017", "description": "INTRA-FRACTION LOCALIZATION AND TRACKING OF TARGET OR PATIENT MOTION DURING DELIVERY OF RADIATION TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237064656" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1866.25, "providers": [{ "billed_charge": 3370.00, "npi": [1558463927] } ] } ] } ] }, { "name": "BHVAL HLTH; LNG-TERM RES PER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0019", "description": "BEHAVIORAL HEALTH; LONG-TERM RESIDENTIAL (NONMEDICAL, NONACUTE CARE IN A RESIDENTIAL TREATMENT PROGR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "946000417" }, "service_code": ["13"], "billing_class": "professional", "payments": [{ "allowed_amount": 21835.11, "providers": [{ "billed_charge": 11145.01, "npi": [1417099789] } ] } ] } ] }, { "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": "330846311" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 541.80, "providers": [{ "billed_charge": 992.00, "npi": [1831109735] } ] } ] } ] }, { "name": "MENTL HLTH SVC PLAN DVLP NON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0032", "description": "MENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NONPHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272992358" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16422.10, "providers": [{ "billed_charge": 18810.00, "npi": [1962736595] } ] } ] } ] }, { "name": "ORAL MEDADMIN DIR OBSERV", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0033", "description": "ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "990998900" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1260.00, "providers": [{ "billed_charge": 1284.30, "npi": [1780435529] } ] } ] } ] }, { "name": "THERAPEUTIC BEHAVIORAL SRVC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H2019", "description": "THERAPEUTIC BEHAVIORAL SERVICES, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272992358" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 27080.95, "providers": [{ "billed_charge": 16847.00, "npi": [1962736595] } ] } ] } ] }, { "name": "BOTULINUM TOXIN TYPE A PER U", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0585", "description": "INJECTION, ONABOTULINUMTOXINA, 1 UNIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330102201" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 34382.00, "providers": [{ "billed_charge": 20640.00, "npi": [1003860537] } ] } ] } ] }, { "name": "INJ TESTOSTERONE CYPION 1MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1071", "description": "INJECTION, TESTOSTERONE CYPIONATE, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330758825" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.00, "providers": [{ "billed_charge": 15.00, "npi": [1689884942] } ] } ] }, { "tin": { "type": "ein", "value": "275548303" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 364.77, "providers": [{ "billed_charge": 572.00, "npi": [1336650068] } ] } ] } ] }, { "name": "INJ TRIAMCINOLON ACETONID NO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3301", "description": "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "956419205" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 332.29, "providers": [{ "billed_charge": 138.00, "npi": [1932121514] } ] } ] }, { "tin": { "type": "ein", "value": "330645967" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 174.26, "providers": [{ "billed_charge": 240.00, "npi": [1649503319] } ] } ] } ] }, { "name": "UNCLASSIFIED DRUGS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3490", "description": "UNCLASSIFIED DRUGS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273834256" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12799.60, "providers": [{ "billed_charge": 6030.00, "npi": [1093016826] } ] } ] } ] }, { "name": "PRSC RX ORAL NONCHEMOTHAPEUT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J8499", "description": "PRESCRIPTION DRUG, ORAL, NONCHEMOTHERAPEUTIC, NOS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "01"], "billing_class": "professional", "payments": [{ "allowed_amount": 2374.90, "providers": [{ "billed_charge": 2374.90, "npi": [] } ] }, { "allowed_amount": 1111.16, "providers": [{ "billed_charge": 1110.35, "npi": [] } ] } ] } ] }, { "name": "STANDARD WHEELCHAIR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "K0001", "description": "STANDARD WHEELCHAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 182.05, "providers": [{ "billed_charge": 169.12, "npi": [1174749972] } ] } ] } ] }, { "name": "ESKETAMINE NASAL SPRAY 1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S0013", "description": "ESKETAMINE NASAL SPRAY 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "990998900" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9324.00, "providers": [{ "billed_charge": 129360.00, "npi": [1780435529] } ] } ] } ] }, { "name": "ONDANSETRON, ORAL, 4 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S0119", "description": "ONDANSETRON, ORAL, 4 MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE STATUTE, USE HCPCS Q CODE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "990998900" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5207.00, "providers": [{ "billed_charge": 894.60, "npi": [1780435529] } ] } ] } ] }, { "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": "934895258" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 6682.05, "providers": [{ "billed_charge": 9225.00, "npi": [1114798071] } ] } ] } ] }, { "name": "SERVICES PROV AN URGENT CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9088", "description": "SERVICES PROVIDED IN AN URGENT CARE CENTER (LIST IN ADDITION TO CODE FOR SERVICE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274666463" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 983.09, "providers": [{ "billed_charge": 500.00, "npi": [1538466107] } ] } ] } ] }, { "name": "NRS CARE HOM; REGISTERED NUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9123", "description": "NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NOT TO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 15488.00, "providers": [{ "billed_charge": 4787.20, "npi": [1477222834] } ] } ] } ] }, { "name": "HOME INFUS TX IMMUOTHAPY; PE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9338", "description": "HOME INFUSION THERAPY, IMMUNOTHERAPY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273281682" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 34656.00, "providers": [{ "billed_charge": 135000.00, "npi": [1346526845] } ] } ] } ] }, { "name": "HT; ENTERAL NUTRIT VIA PUMP;", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9342", "description": "HOME THERAPY; ENTERAL NUTRITION VIA PUMP; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330726408" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13794.00, "providers": [{ "billed_charge": 198.00, "npi": [1922074749] } ] } ] } ] }, { "name": "LACTATION CLASS NON-PHYS PRO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9443", "description": "LACTATION CLASSES, NONPHYSICIAN PROVIDER, PER SESSION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822736113" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 635.08, "providers": [{ "billed_charge": 1800.00, "npi": [1922874890] } ] } ] } ] }, { "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": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 14285.36, "providers": [{ "billed_charge": 1310.26, "npi": [1477222834] } ] } ] } ] }, { "name": "TELEHEALTH TRANS MIN PROF SR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "T1014", "description": "TELEHEALTH TRANSMISSION, PER MINUTE, PROFESSIONAL SERVICES BILL SEPARATELY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.40, "providers": [{ "billed_charge": 9.25, "npi": [1164512851] } ] } ] } ] } ] }