{"reporting_entity_name": "GIIC_TPA","reporting_entity_type": "GIIC_TPA","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"name":"Assay of free testosterone","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84402","description":"Assay of free testosterone","allowed_amounts":[{"tin":{"type":"ein","value":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32.96,"providers":[{"billed_charge":169.02,"npi":[1881630614]}]}]}]},{"name":"Assay of gonadotropin (fsh)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83001","description":"Assay of gonadotropin (fsh)","allowed_amounts":[{"tin":{"type":"ein","value":"362170833"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":330.86,"providers":[{"billed_charge":466.00,"npi":[1235234535]}]}]}]},{"name":"Assay of gonadotropin (lh)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83002","description":"Assay of gonadotropin (lh)","allowed_amounts":[{"tin":{"type":"ein","value":"362170833"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":271.93,"providers":[{"billed_charge":383.00,"npi":[1235234535]}]}]}]},{"name":"Assay of prolactin","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84146","description":"Assay of prolactin","allowed_amounts":[{"tin":{"type":"ein","value":"362170833"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":345.77,"providers":[{"billed_charge":487.00,"npi":[1235234535]}]}]}]},{"name":"Assay of sex hormone globul","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84270","description":"Assay of sex hormone globul","allowed_amounts":[{"tin":{"type":"ein","value":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27.43,"providers":[{"billed_charge":166.20,"npi":[1881630614]}]}]}]},{"name":"Assay of total testosterone","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84403","description":"Assay of total testosterone","allowed_amounts":[{"tin":{"type":"ein","value":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32.58,"providers":[{"billed_charge":171.47,"npi":[1881630614]}]}]}]},{"name":"Chiropract manj 1-2 regions","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"98940","description":"Chiropract manj 1-2 regions","allowed_amounts":[{"tin":{"type":"ein","value":"562403146"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":35.36,"npi":[1215558051]}]}]}]},{"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":82.50,"providers":[{"billed_charge":82.50,"npi":[1477222834]}]}]}]},{"name":"Culture aerobic identify","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87077","description":"Culture aerobic identify","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.38,"providers":[{"billed_charge":21.51,"npi":[1063497451]}]}]}]},{"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":235.15,"npi":[1063497451]}]}]}]},{"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":"462021581"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1619524618]}]}]}]},{"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":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":78.46,"providers":[{"billed_charge":119.22,"npi":[1881630614]}]}]}]},{"name":"Fall risk assessment docd","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3288F","description":"Fall risk assessment docd","allowed_amounts":[{"tin":{"type":"ein","value":"462021581"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1619524618]}]}]}]},{"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":235.20,"npi":[1063497451]}]},{"allowed_amount":45.11,"providers":[{"billed_charge":117.60,"npi":[1063497451]}]}]}]},{"name":"Microbe susceptible mic","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87186","description":"Microbe susceptible mic","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.11,"providers":[{"billed_charge":88.20,"npi":[1063497451]}]}]}]},{"name":"Neuromuscular Reeducation","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97112GO","description":"Neuromuscular Reeducation","allowed_amounts":[{"tin":{"type":"ein","value":"455513255"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":66.87,"providers":[{"billed_charge":66.87,"npi":[1992326730]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"562403146"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":28.29,"providers":[{"billed_charge":28.29,"npi":[1215558051]}]}]}]},{"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":"205818281"},"service_code":["17"],"billing_class":"professional","payments":[{"allowed_amount":75.75,"providers":[{"billed_charge":276.13,"npi":[1356485809,1629427968]}]}]}]},{"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":"363245198"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":144.99,"providers":[{"billed_charge":160.00,"npi":[1770587206]}]}]}]},{"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":"462021581"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":178.00,"providers":[{"billed_charge":405.00,"npi":[1619524618]}]}]}]},{"name":"Psytx pt&\/family 60 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90837","description":"Psytx pt&\/family 60 minutes","allowed_amounts":[{"tin":{"type":"ein","value":"394482092"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":99.00,"providers":[{"billed_charge":99.00,"npi":[1902428535]}]}]}]},{"name":"Psytx pt&\/family 60 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9083795","description":"Psytx pt&\/family 60 minutes","allowed_amounts":[{"tin":{"type":"ein","value":"394482092"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":99.00,"providers":[{"billed_charge":99.00,"npi":[1902428535]}]}]}]},{"name":"Psytx pt&\/family 60 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9083795","description":"Psytx pt&\/family 60 minutes","allowed_amounts":[{"tin":{"type":"ein","value":"812835238"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":102.00,"providers":[{"billed_charge":175.00,"npi":[1023550282]}]}]}]},{"name":"Pt falls assess-docd le1\/yr","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"1101F","description":"Pt falls assess-docd le1\/yr","allowed_amounts":[{"tin":{"type":"ein","value":"462021581"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1619524618]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"362170833"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":63.00,"npi":[1235234535]}]}]}]},{"name":"Therapeutic Exercises","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97110GO","description":"Therapeutic Exercises","allowed_amounts":[{"tin":{"type":"ein","value":"455513255"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":115.42,"providers":[{"billed_charge":115.42,"npi":[1992326730]}]},{"allowed_amount":230.84,"providers":[{"billed_charge":230.84,"npi":[1992326730]}]}]}]},{"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":"205818281"},"service_code":["17"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1356485809,1629427968]}]}]}]},{"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":"462021581"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1619524618]}]}]}]},{"name":"Urine bacteria culture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87088","description":"Urine bacteria culture","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.39,"providers":[{"billed_charge":27.09,"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":27.00,"npi":[1063497451]}]}]}]},{"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":"G221195","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":"453968254"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":20.00,"npi":[1013021286]}]}]}]}]}