{"reporting_entity_name": "GHP_HMO","reporting_entity_type": "GHP_HMO","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"name":"Ambulance Service,Advanced Life Support\/Emergency Level 1","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0427SH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"240512220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":518.07,"providers":[{"billed_charge":925.00,"npi":[1396762217]}]}]}]},{"name":"Anesthesia","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0370","description":"Anesthesia","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":2970.00,"npi":[1790297547]}]},{"allowed_amount":2716.57,"providers":[{"billed_charge":5940.00,"npi":[1790297547]}]}]}]},{"name":"Anesthesia","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0370","description":"Anesthesia","allowed_amounts":[{"tin":{"type":"ein","value":"274564798"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1456.00,"npi":[1881983039]}]},{"allowed_amount":1135.68,"providers":[{"billed_charge":1456.00,"npi":[1881983039]}]}]}]},{"name":"Assay of ck (cpk)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82550","description":"Assay of ck (cpk)","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.36,"providers":[{"billed_charge":45.42,"npi":[1063497451]}]}]}]},{"name":"Assay of ck (cpk)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82550","description":"Assay of ck (cpk)","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":38.42,"providers":[{"billed_charge":190.00,"npi":[1396402053]}]}]}]},{"name":"Assay of lactic acid","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83605","description":"Assay of lactic acid","allowed_amounts":[{"tin":{"type":"ein","value":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":28.30,"providers":[{"billed_charge":170.16,"npi":[1306857974]}]}]}]},{"name":"Assay of lipase","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83690","description":"Assay of lipase","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":33.10,"providers":[{"billed_charge":155.00,"npi":[1396402053]}]}]}]},{"name":"Assay of lipase","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83690","description":"Assay of lipase","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1302.59,"npi":[1841237930]}]}]}]},{"name":"Assay of psa total","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84153","description":"Assay of psa total","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.64,"providers":[{"billed_charge":112.35,"npi":[1063497451]}]}]}]},{"name":"Assay of total thyroxine","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84436","description":"Assay of total thyroxine","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.84,"providers":[{"billed_charge":52.76,"npi":[1063497451]}]}]}]},{"name":"Chylmd trach dna amp probe","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87491","description":"Chylmd trach dna amp probe","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.11,"providers":[{"billed_charge":129.15,"npi":[1063497451]}]}]}]},{"name":"Complete cbc automated","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85027","description":"Complete cbc automated","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":938.47,"npi":[1841237930]}]}]}]},{"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":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":68.60,"providers":[{"billed_charge":150.00,"npi":[1790297547]}]}]}]},{"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":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":49.54,"providers":[{"billed_charge":245.00,"npi":[1396402053]}]},{"allowed_amount":52.31,"providers":[{"billed_charge":245.00,"npi":[1396402053]}]}]}]},{"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":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":30.08,"providers":[{"billed_charge":180.88,"npi":[1306857974]}]}]}]},{"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":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":62.68,"providers":[{"billed_charge":310.00,"npi":[1396402053]}]},{"allowed_amount":66.19,"providers":[{"billed_charge":310.00,"npi":[1396402053]}]}]}]},{"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":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":3806.41,"npi":[1841237930]}]}]}]},{"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":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":72.27,"providers":[{"billed_charge":434.60,"npi":[1306857974]}]}]}]},{"name":"Electrical Stimulation(Unattended)To One Or More Areas For Indication(S)","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G0283GP","description":"Electrical Stimulation(Unattended)To One Or More Areas For Indication(S)","allowed_amounts":[{"tin":{"type":"ein","value":"872132511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12.00,"providers":[{"billed_charge":20.00,"npi":[1760158562]}]}]}]},{"name":"Electroconvulsive Therapy","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"00104QK","description":"Electroconvulsive Therapy","allowed_amounts":[{"tin":{"type":"ein","value":"880689995"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":104.33,"providers":[{"billed_charge":306.00,"npi":[1588647333]}]},{"allowed_amount":105.87,"providers":[{"billed_charge":312.80,"npi":[1497701221]}]},{"allowed_amount":107.40,"providers":[{"billed_charge":319.60,"npi":[1497701221]}]},{"allowed_amount":108.93,"providers":[{"billed_charge":319.60,"npi":[1497701221]}]}]}]},{"name":"Electroconvulsive Therapy","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"00104QX","description":"Electroconvulsive Therapy","allowed_amounts":[{"tin":{"type":"ein","value":"880689995"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":104.33,"providers":[{"billed_charge":306.00,"npi":[1437747268]}]},{"allowed_amount":105.87,"providers":[{"billed_charge":312.80,"npi":[1679666150]}]},{"allowed_amount":107.40,"providers":[{"billed_charge":319.60,"npi":[1558958371]}]},{"allowed_amount":108.93,"providers":[{"billed_charge":319.60,"npi":[1437747268,1679666150]}]},{"allowed_amount":110.47,"providers":[{"billed_charge":326.40,"npi":[1437747268,1558958371]}]},{"allowed_amount":112.00,"providers":[{"billed_charge":333.20,"npi":[1558958371]}]},{"allowed_amount":113.54,"providers":[{"billed_charge":333.20,"npi":[1558958371]}]},{"allowed_amount":116.61,"providers":[{"billed_charge":346.80,"npi":[1679666150]}]}]}]},{"name":"Electroconvulsive Therapy","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"00104QY","description":"Electroconvulsive Therapy","allowed_amounts":[{"tin":{"type":"ein","value":"880689995"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":105.87,"providers":[{"billed_charge":312.80,"npi":[1497701221]}]},{"allowed_amount":108.93,"providers":[{"billed_charge":319.60,"npi":[1497701221,1588647333]}]},{"allowed_amount":110.47,"providers":[{"billed_charge":326.40,"npi":[1497701221]}]},{"allowed_amount":112.00,"providers":[{"billed_charge":333.20,"npi":[1497701221]}]},{"allowed_amount":113.54,"providers":[{"billed_charge":333.20,"npi":[1588647333]}]},{"allowed_amount":116.61,"providers":[{"billed_charge":346.80,"npi":[1497701221]}]}]}]},{"name":"Electroconvulsive therapy","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90870","description":"Electroconvulsive therapy","allowed_amounts":[{"tin":{"type":"ein","value":"274564798"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":2045.07,"providers":[{"billed_charge":2984.00,"npi":[1881983039]},{"billed_charge":3134.00,"npi":[1881983039]}]},{"allowed_amount":2215.98,"providers":[{"billed_charge":2841.00,"npi":[1881983039]}]},{"allowed_amount":2444.52,"providers":[{"billed_charge":3134.00,"npi":[1881983039]}]}]}]},{"name":"Emergency Dept Visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9928325","description":"Emergency Dept Visit","allowed_amounts":[{"tin":{"type":"ein","value":"231352159"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":666.57,"providers":[{"billed_charge":3352.00,"npi":[1932962859]}]}]}]},{"name":"Emergency Dept Visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9928325","description":"Emergency Dept Visit","allowed_amounts":[{"tin":{"type":"ein","value":"640662976"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":155.86,"providers":[{"billed_charge":845.00,"npi":[1598875460]}]}]}]},{"name":"Emergency Dept Visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9928325","description":"Emergency Dept Visit","allowed_amounts":[{"tin":{"type":"ein","value":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":388.24,"providers":[{"billed_charge":2334.66,"npi":[1306857974]}]}]}]},{"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":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":1388.47,"providers":[{"billed_charge":3036.00,"npi":[1790297547]}]}]}]},{"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":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":435.60,"providers":[{"billed_charge":2265.00,"npi":[1396402053]}]},{"allowed_amount":458.00,"providers":[{"billed_charge":2265.00,"npi":[1396402053]}]},{"allowed_amount":483.63,"providers":[{"billed_charge":2265.00,"npi":[1396402053]}]}]}]},{"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":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":5505.86,"npi":[1841237930]}]}]}]},{"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":"231352159"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":217.36,"providers":[{"billed_charge":343.00,"npi":[1811526551]}]}]}]},{"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":"251534212"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":309.64,"providers":[{"billed_charge":715.00,"npi":[1467834309]}]}]}]},{"name":"Emergency dept visit","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99285","description":"Emergency dept visit","allowed_amounts":[{"tin":{"type":"ein","value":"752746578"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":422.25,"providers":[{"billed_charge":1737.00,"npi":[1255074613]}]}]}]},{"name":"General health panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80050","description":"General health panel","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.18,"providers":[{"billed_charge":190.05,"npi":[1063497451]},{"billed_charge":196.61,"npi":[1063497451]}]}]}]},{"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]}]}]}]},{"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":"240512220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":166.32,"providers":[{"billed_charge":192.00,"npi":[1396762217]}]}]}]},{"name":"Hot Or Cold Packs Therapy","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97010GP","description":"Hot Or Cold Packs Therapy","allowed_amounts":[{"tin":{"type":"ein","value":"872132511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":20.00,"npi":[1760158562]}]}]}]},{"name":"Hydration iv infusion init","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96360","description":"Hydration iv infusion init","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":207.26,"providers":[{"billed_charge":1025.00,"npi":[1396402053]}]}]}]},{"name":"IAAD IA HIV-1 AG W\/HIV-1 & HIV-2 ANTBDY SINGLE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87389","description":"IAAD IA HIV-1 AG W\/HIV-1 & HIV-2 ANTBDY SINGLE","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":29.94,"providers":[{"billed_charge":176.40,"npi":[1063497451]}]}]}]},{"name":"Inj heparin sodium per 10 u","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1642","description":"Inj heparin sodium per 10 u","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":2.74,"npi":[1790297547]},{"billed_charge":2.79,"npi":[1790297547]}]}]}]},{"name":"Inj, propofol, 10 mg","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2704","description":"Inj, propofol, 10 mg","allowed_amounts":[{"tin":{"type":"ein","value":"274564798"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":53.00,"npi":[1881983039]}]},{"allowed_amount":41.34,"providers":[{"billed_charge":53.00,"npi":[1881983039]}]}]}]},{"name":"Ketorolac tromethamine inj","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1885JZ","description":"Ketorolac tromethamine inj","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":1.34,"providers":[{"billed_charge":2.94,"npi":[1790297547]}]}]}]},{"name":"Ketorolac tromethamine inj","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1885JZ","description":"Ketorolac tromethamine inj","allowed_amounts":[{"tin":{"type":"ein","value":"231352159"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.99,"providers":[{"billed_charge":5.00,"npi":[1932962859]}]}]}]},{"name":"Ketorolac tromethamine inj","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1885JZ","description":"Ketorolac tromethamine inj","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":18.58,"providers":[{"billed_charge":87.03,"npi":[1396402053]}]}]}]},{"name":"Ketorolac tromethamine inj","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1885JZ","description":"Ketorolac tromethamine inj","allowed_amounts":[{"tin":{"type":"ein","value":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":14.97,"providers":[{"billed_charge":90.00,"npi":[1306857974]}]}]}]},{"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":109.46,"npi":[1063497451]}]}]}]},{"name":"Manual Therapy Techniques 1 Or More Regions 15 Min. Each","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97140GP","description":"Manual Therapy Techniques 1 Or More Regions 15 Min. Each","allowed_amounts":[{"tin":{"type":"ein","value":"872132511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.00,"providers":[{"billed_charge":40.00,"npi":[1760158562]}]}]}]},{"name":"Medical\/surgical supplies and devices","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0270","description":"Medical\/surgical supplies and devices","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":63.10,"providers":[{"billed_charge":137.97,"npi":[1790297547]}]}]}]},{"name":"Morphine sulfate injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2270","description":"Morphine sulfate injection","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":12.21,"npi":[1841237930]}]}]}]},{"name":"Morphine sulfate injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2270","description":"Morphine sulfate injection","allowed_amounts":[{"tin":{"type":"ein","value":"640662976"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":10.33,"providers":[{"billed_charge":56.00,"npi":[1598875460]}]}]}]},{"name":"N.gonorrhoeae dna amp prob","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87591","description":"N.gonorrhoeae dna amp prob","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.11,"providers":[{"billed_charge":129.15,"npi":[1063497451]}]}]}]},{"name":"Normal saline solution infus","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J7030","description":"Normal saline solution infus","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":16.01,"providers":[{"billed_charge":75.00,"npi":[1396402053]}]}]}]},{"name":"Normal saline solution infus","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J7030","description":"Normal saline solution infus","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":623.06,"npi":[1841237930]}]}]}]},{"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":"223376459"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":420.00,"npi":[1871559096]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99215","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"223376459"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":254.04,"providers":[{"billed_charge":590.00,"npi":[1508412271]}]}]}]},{"name":"Ondansetron hcl injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2405","description":"Ondansetron hcl injection","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1.99,"npi":[1790297547]}]}]}]},{"name":"Ondansetron hcl injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2405","description":"Ondansetron hcl injection","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":18.53,"providers":[{"billed_charge":86.79,"npi":[1396402053]}]}]}]},{"name":"Ondansetron hcl injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2405","description":"Ondansetron hcl injection","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":26.04,"npi":[1841237930]}]}]}]},{"name":"Ondansetron hcl injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2405","description":"Ondansetron hcl injection","allowed_amounts":[{"tin":{"type":"ein","value":"640662976"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":7.75,"providers":[{"billed_charge":42.00,"npi":[1598875460]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":16.00,"npi":[1790297547]},{"billed_charge":32.00,"npi":[1790297547]},{"billed_charge":49.16,"npi":[1790297547]}]},{"allowed_amount":0.05,"providers":[{"billed_charge":0.12,"npi":[1790297547]}]},{"allowed_amount":0.21,"providers":[{"billed_charge":0.47,"npi":[1790297547]}]},{"allowed_amount":0.64,"providers":[{"billed_charge":1.41,"npi":[1790297547]}]},{"allowed_amount":0.72,"providers":[{"billed_charge":1.58,"npi":[1790297547]}]},{"allowed_amount":0.89,"providers":[{"billed_charge":1.95,"npi":[1790297547]}]},{"allowed_amount":2.42,"providers":[{"billed_charge":5.30,"npi":[1790297547]}]},{"allowed_amount":13.39,"providers":[{"billed_charge":29.28,"npi":[1790297547]}]},{"allowed_amount":27.44,"providers":[{"billed_charge":60.00,"npi":[1790297547]}]},{"allowed_amount":51.94,"providers":[{"billed_charge":113.58,"npi":[1790297547]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"231352159"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.40,"providers":[{"billed_charge":2.00,"npi":[1932962859]}]},{"allowed_amount":1.70,"providers":[{"billed_charge":8.55,"npi":[1932962859]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":2.87,"providers":[{"billed_charge":14.20,"npi":[1396402053]}]},{"allowed_amount":3.03,"providers":[{"billed_charge":14.20,"npi":[1396402053]}]},{"allowed_amount":6.06,"providers":[{"billed_charge":28.40,"npi":[1396402053]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"274564798"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":348.66,"npi":[1881983039]}]},{"allowed_amount":135.98,"providers":[{"billed_charge":174.33,"npi":[1881983039]}]},{"allowed_amount":407.93,"providers":[{"billed_charge":522.99,"npi":[1881983039]}]}]}]},{"name":"Pharmacy - iv solutions","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0258","description":"Pharmacy - iv solutions","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":7.32,"providers":[{"billed_charge":16.00,"npi":[1790297547]}]},{"allowed_amount":14.63,"providers":[{"billed_charge":32.00,"npi":[1790297547]}]}]}]},{"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":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"221487576"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":20.12,"providers":[{"billed_charge":44.00,"npi":[1790297547]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":11.12,"providers":[{"billed_charge":55.00,"npi":[1396402053]}]},{"allowed_amount":11.74,"providers":[{"billed_charge":55.00,"npi":[1396402053]}]}]}]},{"name":"Succinycholine chloride inj","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J0330","description":"Succinycholine chloride inj","allowed_amounts":[{"tin":{"type":"ein","value":"274564798"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":186.60,"npi":[1881983039]}]},{"allowed_amount":145.55,"providers":[{"billed_charge":186.60,"npi":[1881983039]}]}]}]},{"name":"Ther\/proph\/diag inj iv push","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96374","description":"Ther\/proph\/diag inj iv push","allowed_amounts":[{"tin":{"type":"ein","value":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":92.03,"providers":[{"billed_charge":553.44,"npi":[1306857974]}]}]}]},{"name":"Ther\/proph\/diag inj sc\/im","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96372","description":"Ther\/proph\/diag inj sc\/im","allowed_amounts":[{"tin":{"type":"ein","value":"640662976"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":151.25,"providers":[{"billed_charge":820.00,"npi":[1598875460]}]}]}]},{"name":"Therapeutic Exercises","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97110GP","description":"Therapeutic Exercises","allowed_amounts":[{"tin":{"type":"ein","value":"872132511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":66.00,"providers":[{"billed_charge":71.60,"npi":[1760158562]}]}]}]},{"name":"Tx\/pro\/dx inj new drug addon","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","description":"Tx\/pro\/dx inj new drug addon","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":81.14,"providers":[{"billed_charge":380.00,"npi":[1396402053]}]}]}]},{"name":"Tx\/pro\/dx inj new drug addon","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","description":"Tx\/pro\/dx inj new drug addon","allowed_amounts":[{"tin":{"type":"ein","value":"591479652"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":28291.57,"providers":[{"billed_charge":1054.75,"npi":[1841237930]}]}]}]},{"name":"Tx\/pro\/dx inj new drug addon","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","description":"Tx\/pro\/dx inj new drug addon","allowed_amounts":[{"tin":{"type":"ein","value":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":87.65,"providers":[{"billed_charge":527.09,"npi":[1306857974]}]}]}]},{"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":0.00,"providers":[{"billed_charge":568.08,"npi":[1841237930]}]}]}]},{"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":"840405257"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":32.99,"providers":[{"billed_charge":198.36,"npi":[1306857974]}]}]}]},{"name":"Urinalysis auto w\/scope","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81001","description":"Urinalysis auto w\/scope","allowed_amounts":[{"tin":{"type":"ein","value":"240795623"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":23.49,"providers":[{"billed_charge":110.00,"npi":[1396402053]}]}]}]},{"name":"Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and\/o","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G2211","description":"Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and\/o","allowed_amounts":[{"tin":{"type":"ein","value":"223376459"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":55.00,"npi":[1508412271]}]}]}]}]}
