{"reporting_entity_name": "GIIC_TPA","reporting_entity_type": "GIIC_TPA","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"name":"Body mass index docd","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3008F","description":"Body mass index docd","allowed_amounts":[{"tin":{"type":"ein","value":"262909414"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1750735122]}]}]}]},{"name":"Diast bp 80-89 mm hg","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3079F","description":"Diast bp 80-89 mm hg","allowed_amounts":[{"tin":{"type":"ein","value":"043397450"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1063599686]}]}]}]},{"name":"Diast bp 80-89 mm hg","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3079F","description":"Diast bp 80-89 mm hg","allowed_amounts":[{"tin":{"type":"ein","value":"262909414"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1750735122]}]}]}]},{"name":"Drug test def 8-14 classes","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0481","description":"Drug test def 8-14 classes","allowed_amounts":[{"tin":{"type":"ein","value":"261565558"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":78.38,"providers":[{"billed_charge":320.00,"npi":[1497933162]}]}]}]},{"name":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT,","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80307","description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT,","allowed_amounts":[{"tin":{"type":"ein","value":"261565558"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":37.25,"providers":[{"billed_charge":124.00,"npi":[1497933162]}]}]}]},{"name":"Glycosylated hemoglobin test","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83036","description":"Glycosylated hemoglobin test","allowed_amounts":[{"tin":{"type":"ein","value":"043397450"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.98,"providers":[{"billed_charge":39.00,"npi":[1063599686]}]}]}]},{"name":"Lipid panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"043397450"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13.07,"providers":[{"billed_charge":67.00,"npi":[1063599686]}]}]}]},{"name":"Med nutrition indiv subseq","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9780395","description":"Med nutrition indiv subseq","allowed_amounts":[{"tin":{"type":"ein","value":"823338198"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":55.00,"providers":[{"billed_charge":175.00,"npi":[1104334465]}]},{"allowed_amount":82.50,"providers":[{"billed_charge":262.50,"npi":[1104334465]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"043397450"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":305.77,"providers":[{"billed_charge":387.00,"npi":[1063599686]}]}]}]},{"name":"Radiologic examination, chest; 2 views","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"7104626","description":"Radiologic examination, chest; 2 views","allowed_amounts":[{"tin":{"type":"ein","value":"141825546"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":16.83,"providers":[{"billed_charge":38.00,"npi":[1124018221]}]}]}]},{"name":"Tb test cell immun measure","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86480","description":"Tb test cell immun measure","allowed_amounts":[{"tin":{"type":"ein","value":"043397450"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.65,"providers":[{"billed_charge":249.00,"npi":[1063599686]}]}]}]},{"name":"Tobacco non-user","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"1036F","description":"Tobacco non-user","allowed_amounts":[{"tin":{"type":"ein","value":"262909414"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1750735122]}]}]}]},{"name":"Vitamin b-12","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82607","description":"Vitamin b-12","allowed_amounts":[{"tin":{"type":"ein","value":"043397450"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.16,"providers":[{"billed_charge":61.00,"npi":[1063599686]}]}]}]}]}
