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"allowed_amount": 3.44, "providers": [ { "billed_charge":239.24, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 7.36, "providers": [ { "billed_charge":334.12, "npi": [ 1538144910 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "80053", "description": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Pot", "allowed_amounts": [ { "service_code": ["81"], "billing_class": "professional", "tin": { "type": "ein", "value": "133757370" }, "payments": [ { "allowed_amount": 1.03, "providers": [ { "billed_charge":48.30, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 2.07, "providers": [ { "billed_charge":48.30, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 2.59, "providers": [ { "billed_charge":48.30, "npi": [ 1538144910 ] 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{ "allowed_amount": 99.41, "providers": [ { "billed_charge":36.00, "npi": [ 1366499733 ] } ] } ] }, { "service_code": ["21"], "billing_class": "professional", "tin": { "type": "ein", "value": "1366499733" }, "payments": [ { "allowed_amount": 101.24, "providers": [ { "billed_charge":36.00, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 102.98, "providers": [ { "billed_charge":36.00, "npi": [ 1366499733 ] }, { "billed_charge":72.00, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 3.31, "providers": [ { "billed_charge":36.00, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 36.00, "providers": [ { "billed_charge":36.00, "npi": [ 1366499733 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "80061", "description": "Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)", "allowed_amounts": 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"allowed_amount": 173.17, "providers": [ { "billed_charge":20.50, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 20.50, "providers": [ { "billed_charge":20.50, "npi": [ 1366499733 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "81000", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy", "allowed_amounts": [ { "service_code": ["20"], "billing_class": "professional", "tin": { "type": "ein", "value": "541973284" }, "payments": [ { "allowed_amount": 37.00, "providers": [ { "billed_charge":37.00, "npi": [ 1417913310 ] } ] }, { "allowed_amount": 4.66, "providers": [ { "billed_charge":37.00, "npi": [ 1528024379, 1033191564, 1891790994, 1417913310, 1588856132, 1023074937, 1982753216, 1184627747, 1083666168, 1770548893, 1770967796, 1164524922, 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"providers": [ { "billed_charge":15.00, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 54.71, "providers": [ { "billed_charge":15.00, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 55.64, "providers": [ { "billed_charge":15.00, "npi": [ 1366499733 ] } ] } ] }, { "service_code": ["21"], "billing_class": "professional", "tin": { "type": "ein", "value": "1366499733" }, "payments": [ { "allowed_amount": 15.00, "providers": [ { "billed_charge":15.00, "npi": [ 1366499733 ] } ] }, { "allowed_amount": 55.64, "providers": [ { "billed_charge":15.00, "npi": [ 1366499733 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "81002", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy", "allowed_amounts": [ { "service_code": ["20"], "billing_class": "professional", "tin": { "type": "ein", "value": "541973284" }, "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge":25.00, "npi": [ 1407837495, 1528024379, 1982753216, 1164524922, 1023074937, 1083666168, 1770548893, 1700291689, 1467818112, 1417913310, 1184627747, 1568676070, 1194780205, 1588856132, 1770967796, 1033191564 ] } ] }, { "allowed_amount": 4.48, "providers": [ { "billed_charge":25.00, "npi": [ 1528024379, 1033191564, 1164524922, 1700291689, 1417913310, 1467818112, 1770548893, 1174552012, 1982753216, 1184627747, 1770967796 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "81003", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy", "allowed_amounts": [ { "service_code": ["11"], "billing_class": "professional", "tin": { "type": "ein", "value": "202265068" }, "payments": [ { "allowed_amount": 3.92, "providers": [ { "billed_charge":8.00, "npi": [ 1588954978, 1700992567 ] } ] }, { "allowed_amount": 4.09, "providers": [ { "billed_charge":8.00, "npi": [ 1346223955, 1548244056 ] } ] }, { "allowed_amount": 4.10, "providers": [ { "billed_charge":8.00, "npi": [ 1790916039 ] } ] }, { "allowed_amount": 4.12, "providers": [ { "billed_charge":8.00, "npi": [ 1326030438 ] } ] }, { "allowed_amount": 4.34, "providers": [ { "billed_charge":8.00, "npi": [ 1588954978 ] } ] }, { "allowed_amount": 4.61, "providers": [ { "billed_charge":8.00, "npi": [ 1346223955, 1447241997 ] } ] }, { "allowed_amount": 4.63, "providers": [ { "billed_charge":8.00, "npi": [ 1891767000, 1598127003, 1013913284 ] } ] }, { "allowed_amount": 4.65, "providers": [ { "billed_charge":8.00, "npi": [ 1326030438 ] } ] }, { "allowed_amount": 5.11, "providers": [ { "billed_charge":8.00, "npi": [ 1346223955, 1285098574 ] } ] }, { "allowed_amount": 5.15, "providers": [ { "billed_charge":8.00, "npi": [ 1326030438 ] } ] }, { "allowed_amount": 8.00, "providers": [ { "billed_charge":8.00, "npi": [ 1013042480, 1700268356 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "81025", "description": "Urine pregnancy test, by visual color comparison methods", "allowed_amounts": [ { "service_code": ["20"], "billing_class": "professional", "tin": { "type": "ein", "value": "541973284" }, "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge":63.00, "npi": [ 1184627747, 1770548893, 1083666168, 1417913310, 1164524922, 1528024379, 1588856132, 1033191564 ] } ] }, { "allowed_amount": 11.11, "providers": [ { "billed_charge":63.00, "npi": [ 1982753216, 1588856132 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "82306", "description": "Vitamin D; 25 hydroxy, includes fraction(s), if performed", "allowed_amounts": [ { "service_code": ["81"], "billing_class": "professional", "tin": { "type": "ein", "value": "133757370" }, "payments": [ { "allowed_amount": 2.90, "providers": [ { "billed_charge":243.60, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 232.00, "providers": [ { "billed_charge":232.00, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 243.60, "providers": [ { "billed_charge":243.60, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 27.33, "providers": [ { "billed_charge":243.60, "npi": [ 1538144910 ] }, { "billed_charge":250.19, "npi": [ 1538144910 ] }, { "billed_charge":246.28, "npi": [ 1538144910 ] }, { "billed_charge":312.26, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 5.80, "providers": [ { "billed_charge":243.60, "npi": [ 1538144910 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "82962", "description": "Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use", "allowed_amounts": [ { "service_code": ["11"], "billing_class": "professional", "tin": { "type": "ein", "value": "202265068" }, "payments": [ { "allowed_amount": 3.76, "providers": [ { "billed_charge":8.00, "npi": [ 1457481947, 1518271071, 1821133091, 1255336673, 1265604870, 1003811423, 1033186531, 1881649556 ] } ] }, { "allowed_amount": 4.18, "providers": [ { "billed_charge":8.00, "npi": [ 1821133091, 1831200203, 1518271071, 1508804790, 1003811423, 1992980619 ] } ] }, { "allowed_amount": 4.46, "providers": [ { "billed_charge":8.00, "npi": [ 1164492401 ] } ] }, { "allowed_amount": 8.00, "providers": [ { "billed_charge":8.00, "npi": [ 1013042480 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "83036", "description": "Hemoglobin; glycosylated (A1C)", "allowed_amounts": [ { "service_code": ["81"], "billing_class": "professional", "tin": { "type": "ein", "value": "133757370" }, "payments": [ { "allowed_amount": 0.95, "providers": [ { "billed_charge":69.30, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 69.30, "providers": [ { "billed_charge":69.30, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 74.90, "providers": [ { "billed_charge":74.90, "npi": [ 1538144910 ] } ] }, { "allowed_amount": 8.96, "providers": [ { "billed_charge":75.89, "npi": [ 1538144910 ] }, { "billed_charge":80.80, "npi": [ 1164505830 ] }, { "billed_charge":71.98, "npi": [ 1538144910 ] }, { "billed_charge":69.30, "npi": [ 1538144910 ] }, { "billed_charge":70.15, "npi": [ 1538144910 ] } ] } ] }, { "service_code": ["81"], "billing_class": "professional", "tin": { "type": "ein", "value": "520591656" }, "payments": [ { "allowed_amount": 6.99, "providers": [ { "billed_charge":32.00, "npi": [ 1992803266 ] } ] }, { "allowed_amount": 7.43, "providers": [ { "billed_charge":32.00, "npi": [ 1992803266 ] } ] } ] }, { "service_code": ["11"], "billing_class": "professional", "tin": { "type": "ein", "value": "1992810550" }, "payments": [ { "allowed_amount": 11.53, "providers": [ { "billed_charge":60.00, "npi": [ 1992810550 ] } ] }, { "allowed_amount": 12.99, "providers": [ { "billed_charge":60.00, "npi": [ 1992810550 ] } ] } ] }, { "service_code": ["11"], "billing_class": "professional", "tin": { "type": "ein", "value": "202265068" }, "payments": [ { "allowed_amount": 12.39, "providers": [ { "billed_charge":33.00, "npi": [ 1518271071 ] } ] }, { "allowed_amount": 12.55, "providers": [ { "billed_charge":33.00, "npi": [ 1033186531, 1881649556, 1457481947, 1003811423, 1265604870, 1255336673, 1518271071, 1821133091 ] } ] }, { "allowed_amount": 13.94, "providers": [ { "billed_charge":33.00, "npi": [ 1003811423, 1831200203, 1821133091, 1518271071, 1508804790 ] } ] }, { "allowed_amount": 14.37, "providers": [ { "billed_charge":33.00, "npi": [ 1104888973, 1770545394 ] } ] }, { "allowed_amount": 14.56, "providers": [ { "billed_charge":33.00, "npi": [ 1104888973, 1750343547, 1497717250, 1992718118, 1629171939 ] } ] }, { "allowed_amount": 16.01, "providers": [ { "billed_charge":33.00, "npi": [ 1326030438 ] } ] }, { "allowed_amount": 17.79, "providers": [ { "billed_charge":33.00, "npi": [ 1326030438 ] } ] }, { "allowed_amount": 17.86, "providers": [ { "billed_charge":33.00, "npi": [ 1285098574 ] } ] }, { "allowed_amount": 17.94, "providers": [ { "billed_charge":33.00, "npi": [ 1598127003, 1013913284 ] } ] }, { "allowed_amount": 18.02, "providers": [ { "billed_charge":33.00, "npi": [ 1326030438 ] } ] }, { "allowed_amount": 20.01, "providers": [ { "billed_charge":33.00, "npi": [ 1326030438 ] } ] } ] } ] }, { "name": "OTHERS", "billing_code_type": "CPT", "billing_code_type_version": "10", "billing_code": "83605", "description": "Lactate (lactic acid)", "allowed_amounts": [ { "service_code": ["22"], "billing_class": "professional", "tin": { "type": "ein", "value": "1366499733" }, "payments": [ { "allowed_amount": 30.78, "providers": [ { "billed_charge":16.00, "npi": [ 1366499733 ] }, { 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