{"reporting_entity_name": "GQO_PPO","reporting_entity_type": "GQO_PPO","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]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.44,"providers":[{"billed_charge":71.52,"npi":[1255314704]}]}]}]},{"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":"232318530"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":900.00,"providers":[{"billed_charge":1200.00,"npi":[1669454419]}]}]}]},{"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":"232318530"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":900.00,"providers":[{"billed_charge":1200.00,"npi":[1669454419]}]}]}]},{"name":"Assay of estradiol","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82670","description":"Assay of estradiol","allowed_amounts":[{"tin":{"type":"ein","value":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":65.92,"providers":[{"billed_charge":467.69,"npi":[1538244918]}]}]}]},{"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":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.86,"providers":[{"billed_charge":20.00,"npi":[1730353590]}]}]}]},{"name":"Assay of folic acid serum","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82746","description":"Assay of folic acid serum","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.90,"providers":[{"billed_charge":100.60,"npi":[1255314704]}]}]}]},{"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":60.11,"providers":[{"billed_charge":427.26,"npi":[1538244918]}]}]}]},{"name":"Assay of free thyroxine","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84439","description":"Assay of free thyroxine","allowed_amounts":[{"tin":{"type":"ein","value":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.91,"providers":[{"billed_charge":35.00,"npi":[1730353590]}]}]}]},{"name":"Assay of free thyroxine","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84439","description":"Assay of free thyroxine","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.59,"providers":[{"billed_charge":71.52,"npi":[1255314704]}]}]}]},{"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":43.85,"providers":[{"billed_charge":503.45,"npi":[1538244918]}]}]}]},{"name":"Assay of insulin","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83525","description":"Assay of insulin","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14.70,"providers":[{"billed_charge":78.75,"npi":[1255314704]}]}]}]},{"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":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.86,"providers":[{"billed_charge":16.00,"npi":[1730353590]}]}]}]},{"name":"Assay of progesterone","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84144","description":"Assay of progesterone","allowed_amounts":[{"tin":{"type":"ein","value":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":49.22,"providers":[{"billed_charge":352.76,"npi":[1538244918]}]}]}]},{"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 testosterone","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84403","description":"Assay of total testosterone","allowed_amounts":[{"tin":{"type":"ein","value":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":60.91,"providers":[{"billed_charge":430.37,"npi":[1538244918]}]}]}]},{"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]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.65,"providers":[{"billed_charge":63.93,"npi":[1255314704]}]}]}]},{"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":39.64,"providers":[{"billed_charge":279.69,"npi":[1538244918]}]}]}]},{"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":"462263183"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1114191079]}]}]}]},{"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":"832124345"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1083676910]}]}]}]},{"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":15.28,"providers":[{"billed_charge":104.15,"npi":[1538244918]}]}]}]},{"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]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.81,"providers":[{"billed_charge":54.65,"npi":[1932166386]}]}]}]},{"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":"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":24.90,"providers":[{"billed_charge":136.79,"npi":[1538244918]}]}]}]},{"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":"821682066"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":556.80,"providers":[{"billed_charge":696.00,"npi":[1235669110]}]}]}]},{"name":"Culture othr specimn aerobic","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87070","description":"Culture othr specimn aerobic","allowed_amounts":[{"tin":{"type":"ein","value":"821682066"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":687.20,"providers":[{"billed_charge":859.00,"npi":[1235669110]}]}]}]},{"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":"462263183"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1114191079]}]}]}]},{"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":205.20,"providers":[{"billed_charge":1280.00,"npi":[1932703022]}]}]}]},{"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":"821682066"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":1955.20,"providers":[{"billed_charge":2444.00,"npi":[1235669110]}]}]}]},{"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":"853811409"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":176.85,"providers":[{"billed_charge":1324.00,"npi":[1821733312]}]}]}]},{"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":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.89,"providers":[{"billed_charge":149.00,"npi":[1730353590]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.18,"providers":[{"billed_charge":214.08,"npi":[1255314704]}]}]}]},{"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":22.91,"providers":[{"billed_charge":219.10,"npi":[1538244918]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.46,"providers":[{"billed_charge":69.30,"npi":[1255314704]}]}]}]},{"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":"232318530"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":193.50,"providers":[{"billed_charge":258.00,"npi":[1669454419]}]}]}]},{"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":"232318530"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":208.50,"providers":[{"billed_charge":278.00,"npi":[1669454419]}]}]}]},{"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":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.76,"providers":[{"billed_charge":25.00,"npi":[1730353590]}]}]}]},{"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":97.65,"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":31.58,"providers":[{"billed_charge":191.14,"npi":[1538244918]}]}]}]},{"name":"Lipid panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.86,"providers":[{"billed_charge":74.00,"npi":[1730353590]}]}]}]},{"name":"Lipid panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16.74,"providers":[{"billed_charge":102.90,"npi":[1255314704]}]}]}]},{"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":"821682066"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":524.80,"providers":[{"billed_charge":656.00,"npi":[1235669110]}]}]}]},{"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":"272406803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":84.58,"providers":[{"billed_charge":266.15,"npi":[1356372429]}]}]}]},{"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":"311575051"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":33.90,"providers":[{"billed_charge":298.00,"npi":[1235522475]}]}]}]},{"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":"272406803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":84.58,"providers":[{"billed_charge":266.15,"npi":[1356372429]}]}]}]},{"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":"311575051"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":67.80,"providers":[{"billed_charge":298.00,"npi":[1235522475]}]}]}]},{"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":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":120.42,"providers":[{"billed_charge":372.00,"npi":[1235274663]}]}]}]},{"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":"832124345"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":175.10,"providers":[{"billed_charge":530.00,"npi":[1083676910]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"821682066"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":8.00,"providers":[{"billed_charge":10.00,"npi":[1235669110]}]}]}]},{"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":"205155995"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":18.00,"npi":[1083701452]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":34.20,"npi":[1538244918]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":15.00,"npi":[1730353590]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2.75,"providers":[{"billed_charge":26.25,"npi":[1255314704]}]}]}]},{"name":"Specimen handling office-lab","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99000","description":"Specimen handling office-lab","allowed_amounts":[{"tin":{"type":"ein","value":"462263183"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":20.00,"npi":[1114191079]}]}]}]},{"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":"462263183"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1114191079]}]}]}]},{"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":"832124345"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1083676910]}]}]}]},{"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":37.80,"npi":[1063497451]}]}]}]},{"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":"611141828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.35,"providers":[{"billed_charge":23.00,"npi":[1730353590]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4.07,"providers":[{"billed_charge":37.80,"npi":[1255314704]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.37,"providers":[{"billed_charge":75.60,"npi":[1255314704]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19.37,"providers":[{"billed_charge":103.10,"npi":[1255314704]}]}]}]},{"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]}]}]}]},{"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":"610444707"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":69.84,"providers":[{"billed_charge":458.33,"npi":[1538244918]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.04,"providers":[{"billed_charge":243.60,"npi":[1255314704]}]}]}]},{"name":"Waiver service, nos","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"T2025","description":"Waiver service, nos","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":100.00,"providers":[{"billed_charge":110.00,"npi":[]}]}]}]}]}