{"reporting_entity_name": "GIIC_TPA","reporting_entity_type": "GIIC_TPA","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":71.53,"npi":[1063497451]}]}]}]},{"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":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5.75,"providers":[{"billed_charge":70.00,"npi":[1710064811]}]}]}]},{"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":"391083015"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":56.13,"providers":[{"billed_charge":77.00,"npi":[1659783264]}]}]}]},{"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":"246022641"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":713.13,"providers":[{"billed_charge":1350.00,"npi":[1740358423]}]}]}]},{"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 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":"201236503"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.75,"providers":[{"billed_charge":73.56,"npi":[1225110497]}]}]}]},{"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":63.92,"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":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4.97,"providers":[{"billed_charge":60.00,"npi":[1710064811]}]}]}]},{"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":"391083015"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":45.20,"providers":[{"billed_charge":62.00,"npi":[1659783264]}]}]}]},{"name":"Breast tomosynthesis bi","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","description":"Breast tomosynthesis bi","allowed_amounts":[{"tin":{"type":"ein","value":"390806347"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":114.75,"providers":[{"billed_charge":135.00,"npi":[1861557753]}]}]}]},{"name":"Breast tomosynthesis bi","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","description":"Breast tomosynthesis bi","allowed_amounts":[{"tin":{"type":"ein","value":"710236856"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":267.00,"npi":[1043240682]}]}]}]},{"name":"Brief emotional\/behav assmt","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96127","description":"Brief emotional\/behav assmt","allowed_amounts":[{"tin":{"type":"ein","value":"581728803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.38,"providers":[{"billed_charge":17.00,"npi":[1629039862]}]}]}]},{"name":"Chiropract manj 3-4 regions","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98941","description":"Chiropract manj 3-4 regions","allowed_amounts":[{"tin":{"type":"ein","value":"392016239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.50,"providers":[{"billed_charge":80.00,"npi":[1124170675]}]}]}]},{"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]}]}]}]},{"name":"Cont airway pressure device","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0601RR","description":"Cont airway pressure device","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":93.13,"providers":[{"billed_charge":93.13,"npi":[1477222834]}]}]}]},{"name":"Cytopath c\/v auto fluid redo","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88175","description":"Cytopath c\/v auto fluid redo","allowed_amounts":[{"tin":{"type":"ein","value":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.87,"providers":[{"billed_charge":170.00,"npi":[1710064811]}]}]}]},{"name":"Cytopath c\/v interpret","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88141","description":"Cytopath c\/v interpret","allowed_amounts":[{"tin":{"type":"ein","value":"391102739"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":126.54,"providers":[{"billed_charge":222.00,"npi":[1467662080]}]}]}]},{"name":"Detect agnt mult dna ampli","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87801","description":"Detect agnt mult dna ampli","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":90.22,"providers":[{"billed_charge":197.37,"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":72.48,"providers":[{"billed_charge":100.80,"npi":[1063497451]}]}]}]},{"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":"550643304"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":2012.10,"providers":[{"billed_charge":2118.00,"npi":[1841271459]}]}]}]},{"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":"205581660"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":479.40,"providers":[{"billed_charge":1693.00,"npi":[1487619128]}]}]}]},{"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":"232804207"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":325.16,"providers":[{"billed_charge":450.00,"npi":[1780888578]}]}]}]},{"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":"273953335"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":128.00,"providers":[{"billed_charge":1870.00,"npi":[1144289968]}]},{"allowed_amount":1152.00,"providers":[{"billed_charge":1280.00,"npi":[1588918650]}]}]}]},{"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":"273953335"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":572.78,"providers":[{"billed_charge":1870.00,"npi":[1457131971]}]}]}]},{"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":"311603722"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1634.55,"providers":[{"billed_charge":1923.00,"npi":[1386691780]}]}]}]},{"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]}]}]}]},{"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":"201236503"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.49,"providers":[{"billed_charge":140.52,"npi":[1225110497]}]}]}]},{"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":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31.10,"providers":[{"billed_charge":225.00,"npi":[1710064811]}]}]}]},{"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":"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":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.41,"providers":[{"billed_charge":80.00,"npi":[1710064811]}]}]}]},{"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":"246022641"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":63.59,"providers":[{"billed_charge":125.00,"npi":[1740358423]}]}]}]},{"name":"Hepatitis c ab test","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86803","description":"Hepatitis c ab test","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.34,"providers":[{"billed_charge":112.35,"npi":[1063497451]}]}]}]},{"name":"Hospital Outpt Clinic Visit","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G046325","description":"Hospital Outpt Clinic Visit","allowed_amounts":[{"tin":{"type":"ein","value":"550643304"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":128.25,"providers":[{"billed_charge":135.00,"npi":[1841271459]}]}]}]},{"name":"Hpv high-risk types","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87624","description":"Hpv high-risk types","allowed_amounts":[{"tin":{"type":"ein","value":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":120.00,"providers":[{"billed_charge":240.00,"npi":[1710064811]}]}]}]},{"name":"Humidifier heated used w pap","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E0562RR","description":"Humidifier heated used w pap","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":17.60,"providers":[{"billed_charge":17.60,"npi":[1477222834]}]}]}]},{"name":"Infec Agent Detection Be Nucleic Acid Amp. Probe Tech","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"8779859","description":"Infec Agent Detection Be Nucleic Acid Amp. Probe Tech","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":235.92,"npi":[1063497451]}]},{"allowed_amount":45.11,"providers":[{"billed_charge":117.96,"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]}]}]}]},{"name":"Lipid panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"201236503"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.10,"providers":[{"billed_charge":53.56,"npi":[1225110497]}]}]}]},{"name":"Lipid panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21.69,"providers":[{"billed_charge":130.00,"npi":[1710064811]}]}]}]},{"name":"Med serv 10pm-8am 24 hr fac","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99053","description":"Med serv 10pm-8am 24 hr fac","allowed_amounts":[{"tin":{"type":"ein","value":"205581660"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":59.00,"npi":[1487619128]}]}]}]},{"name":"Office\/Outpatient Visit, Est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921325","description":"Office\/Outpatient Visit, Est","allowed_amounts":[{"tin":{"type":"ein","value":"842703208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":67.00,"providers":[{"billed_charge":173.72,"npi":[1427081025]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"391678306"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":331.50,"providers":[{"billed_charge":390.00,"npi":[1316423056]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"431704371"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":141.66,"providers":[{"billed_charge":449.40,"npi":[1770516064]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"710485626"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":89.49,"providers":[{"billed_charge":210.00,"npi":[1619955945]}]}]}]},{"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":"391083015"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":286.50,"providers":[{"billed_charge":393.00,"npi":[1659783264]}]}]}]},{"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":"453949590"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":99.24,"providers":[{"billed_charge":160.00,"npi":[1225253248]}]}]}]},{"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":"581728803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":228.77,"providers":[{"billed_charge":291.00,"npi":[1629039862]}]}]}]},{"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":"621668434"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":117.57,"providers":[{"billed_charge":333.13,"npi":[1487910691]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"550643304"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":1.43,"providers":[{"billed_charge":1.50,"npi":[1841271459]}]}]}]},{"name":"Pos airway pressure filter","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A7038","description":"Pos airway pressure filter","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":15.84,"providers":[{"billed_charge":15.84,"npi":[1477222834]}]}]}]},{"name":"Prothrombin time","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85610","description":"Prothrombin time","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5.05,"providers":[{"billed_charge":33.24,"npi":[1063497451]}]}]}]},{"name":"Pt inelig neg scrn depres","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G8510","description":"Pt inelig neg scrn depres","allowed_amounts":[{"tin":{"type":"ein","value":"581728803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1629039862]}]}]}]},{"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":"431704371"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":11.39,"providers":[{"billed_charge":63.00,"npi":[1114363850]}]}]}]},{"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":"201236503"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":34.28,"npi":[1225110497]}]}]}]},{"name":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","allowed_amounts":[{"tin":{"type":"ein","value":"390806347"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":391.00,"providers":[{"billed_charge":460.00,"npi":[1861557753]}]}]}]},{"name":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","allowed_amounts":[{"tin":{"type":"ein","value":"710236856"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":503.00,"npi":[1043240682]}]}]}]},{"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":"550643304"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":187.00,"npi":[1841271459]}]}]}]},{"name":"Tubing with heating element","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A4604","description":"Tubing with heating element","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":47.40,"providers":[{"billed_charge":47.40,"npi":[1477222834]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4.07,"providers":[{"billed_charge":32.55,"npi":[1063497451]}]}]}]},{"name":"Urine culture\/colony count","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87086","description":"Urine culture\/colony count","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.37,"providers":[{"billed_charge":75.60,"npi":[1063497451]}]}]}]},{"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":"205657908"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14.64,"providers":[{"billed_charge":145.00,"npi":[1710064811]}]}]}]},{"name":"Vitamin d 25 hydroxy","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82306","description":"Vitamin d 25 hydroxy","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.04,"providers":[{"billed_charge":286.65,"npi":[1063497451]}]}]}]}]}
