{"reporting_entity_name": "GHP_HMO","reporting_entity_type": "GHP_HMO","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"name":"Albumin; urine (eg, microalbumin), quantitative","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82043","description":"Albumin; urine (eg, microalbumin), quantitative","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.44,"providers":[{"billed_charge":68.20,"npi":[1063497451]},{"billed_charge":71.53,"npi":[1063497451]}]}]}]},{"name":"Alcohol and\/or drug services","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"H0015","description":"Alcohol and\/or drug services","allowed_amounts":[{"tin":{"type":"ein","value":"874570277"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":275.00,"providers":[{"billed_charge":2495.00,"npi":[1033845029]}]},{"allowed_amount":623.75,"providers":[{"billed_charge":2495.00,"npi":[1033845029]}]}]}]},{"name":"Ambulance Service Basic Life Support\/Emergency","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0429RH","description":"Ambulance Service Basic Life Support\/Emergency","allowed_amounts":[{"tin":{"type":"ein","value":"236395539"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":436.27,"providers":[{"billed_charge":850.00,"npi":[1114080892]}]}]}]},{"name":"Ambulance Service Basic Life Support\/Emergency","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0429RH","description":"Ambulance Service Basic Life Support\/Emergency","allowed_amounts":[{"tin":{"type":"ein","value":"237241849"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2000.00,"providers":[{"billed_charge":2000.00,"npi":[1528046398]}]}]}]},{"name":"Ambulance Service Basic Life Support\/Emergency","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0429RH","description":"Ambulance Service Basic Life Support\/Emergency","allowed_amounts":[{"tin":{"type":"ein","value":"246024144"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1100.00,"providers":[{"billed_charge":1100.00,"npi":[1891854840]}]}]}]},{"name":"Ambulance Service Basic Life Support\/Emergency","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0429SH","description":"Ambulance Service Basic Life Support\/Emergency","allowed_amounts":[{"tin":{"type":"ein","value":"232790049"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":436.27,"providers":[{"billed_charge":630.00,"npi":[1912920588]}]}]}]},{"name":"Ambulance Service,Advanced Life Support\/Emergency Level 1","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0427EH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"232625750"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1400.00,"providers":[{"billed_charge":1400.00,"npi":[1861480949]}]}]}]},{"name":"Ambulance Service,Advanced Life Support\/Emergency Level 1","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0427RH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"232716811"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1300.00,"providers":[{"billed_charge":1300.00,"npi":[1528054699]}]}]}]},{"name":"Assay of ferritin","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82728","description":"Assay of ferritin","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.50,"providers":[{"billed_charge":79.50,"npi":[1063497451]}]}]}]},{"name":"Assay of iron","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83540","description":"Assay of iron","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.32,"providers":[{"billed_charge":57.09,"npi":[1063497451]}]}]}]},{"name":"Assay of urine creatinine","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82570","description":"Assay of urine creatinine","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.65,"providers":[{"billed_charge":60.95,"npi":[1063497451]},{"billed_charge":63.92,"npi":[1063497451]}]}]}]},{"name":"Assay thyroid stim hormone","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84443","description":"Assay thyroid stim hormone","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21.59,"providers":[{"billed_charge":109.20,"npi":[1063497451]}]}]}]},{"name":"Complete cbc w\/auto diff wbc","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","description":"Complete cbc w\/auto diff wbc","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.99,"providers":[{"billed_charge":32.55,"npi":[1063497451]},{"billed_charge":36.30,"npi":[1063497451]}]}]}]},{"name":"Comprehen metabolic panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"Comprehen metabolic panel","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.60,"providers":[{"billed_charge":48.30,"npi":[1063497451]},{"billed_charge":52.05,"npi":[1063497451]}]}]}]},{"name":"Drug test def 1-7 classes","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0480","description":"Drug test def 1-7 classes","allowed_amounts":[{"tin":{"type":"ein","value":"821256541"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":238.01,"providers":[{"billed_charge":2265.00,"npi":[1952876203]}]},{"allowed_amount":1812.00,"providers":[{"billed_charge":2265.00,"npi":[1952876203]}]}]}]},{"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":"821256541"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":850.00,"npi":[1952876203]}]},{"allowed_amount":72.00,"providers":[{"billed_charge":850.00,"npi":[1952876203]}]},{"allowed_amount":680.00,"providers":[{"billed_charge":850.00,"npi":[1952876203]}]}]}]},{"name":"Emergency Dept Visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9928425","description":"Emergency Dept Visit","allowed_amounts":[{"tin":{"type":"ein","value":"845095889"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1342.00,"npi":[1750567772]}]}]}]},{"name":"Emergency dept visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","description":"Emergency dept visit","allowed_amounts":[{"tin":{"type":"ein","value":"232919472"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":185.43,"providers":[{"billed_charge":330.00,"npi":[1114373289]}]}]}]},{"name":"Emergency dept visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","description":"Emergency dept visit","allowed_amounts":[{"tin":{"type":"ein","value":"461322238"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":143.82,"providers":[{"billed_charge":305.00,"npi":[1740671148]}]}]}]},{"name":"Emergency dept visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","description":"Emergency dept visit","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":776.74,"providers":[{"billed_charge":5505.86,"npi":[1841237930]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.46,"providers":[{"billed_charge":69.30,"npi":[1063497451]},{"billed_charge":73.05,"npi":[1063497451]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425EH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"232625750"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":150.00,"providers":[{"billed_charge":150.00,"npi":[1861480949]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425RH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"232716811"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":250.00,"providers":[{"billed_charge":250.00,"npi":[1528054699]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425RH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"236395539"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":244.86,"providers":[{"billed_charge":324.00,"npi":[1114080892]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425RH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"237241849"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":560.00,"providers":[{"billed_charge":560.00,"npi":[1528046398]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425RH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"246024144"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":250.00,"providers":[{"billed_charge":250.00,"npi":[1891854840]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425SH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"232790049"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":503.58,"providers":[{"billed_charge":829.80,"npi":[1912920588]}]}]}]},{"name":"Iron binding test","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83550","description":"Iron binding test","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.24,"providers":[{"billed_charge":35.31,"npi":[1063497451]}]}]}]},{"name":"Lipid panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16.74,"providers":[{"billed_charge":102.90,"npi":[1063497451]},{"billed_charge":106.65,"npi":[1063497451]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"250965480"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.98,"providers":[{"billed_charge":3.50,"npi":[1821007881]}]}]}]},{"name":"Portable gaseous 02","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0431RR","description":"Portable gaseous 02","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":11.16,"providers":[{"billed_charge":27.90,"npi":[1477222834]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2.75,"providers":[{"billed_charge":26.25,"npi":[1063497451]}]}]}]},{"name":"Subsequent hospital care","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99233","description":"Subsequent hospital care","allowed_amounts":[{"tin":{"type":"ein","value":"462866213"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":113.35,"providers":[{"billed_charge":412.00,"npi":[1710032131]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":79.66,"providers":[{"billed_charge":238.35,"npi":[1063497451]}]}]}]},{"name":"Urinalysis auto w\/o scope","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81003","description":"Urinalysis auto w\/o scope","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":80.14,"providers":[{"billed_charge":568.08,"npi":[1841237930]}]}]}]}]}