{"reporting_entity_name": "GIIC_TPA","reporting_entity_type": "GIIC_TPA","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"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":"590724459"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":439.78,"providers":[{"billed_charge":2052.50,"npi":[1306938071]}]}]}]},{"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":"591281714"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1071.00,"npi":[1811983752]}]}]}]},{"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":"273645560"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":143.09,"providers":[{"billed_charge":172.00,"npi":[1801011440]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921495","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"815076008"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":79.96,"providers":[{"billed_charge":240.00,"npi":[1902495195]}]}]}]},{"name":"Psytx pt&\/fam w\/e&m 30 min","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9083395","description":"Psytx pt&\/fam w\/e&m 30 min","allowed_amounts":[{"tin":{"type":"ein","value":"815076008"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":38.00,"providers":[{"billed_charge":180.00,"npi":[1902495195]}]}]}]}]}