{"reporting_entity_name": "GIIC_TPA","reporting_entity_type": "GIIC_TPA","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":"A0427RH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"232514298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2160.00,"providers":[{"billed_charge":2400.00,"npi":[1811996283]}]}]}]},{"name":"Anesthesia","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0370","description":"Anesthesia","allowed_amounts":[{"tin":{"type":"ein","value":"161165049"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":2428.08,"providers":[{"billed_charge":8840.00,"npi":[1518998699]}]}]}]},{"name":"Anesthesia","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0370","description":"Anesthesia","allowed_amounts":[{"tin":{"type":"ein","value":"540506332"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":2279.52,"providers":[{"billed_charge":3166.00,"npi":[1033102942]}]}]}]},{"name":"Assay of apolipoprotein","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82172","description":"Assay of apolipoprotein","allowed_amounts":[{"tin":{"type":"ein","value":"250965414"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":31.64,"providers":[{"billed_charge":67.00,"npi":[1821015462]}]}]}]},{"name":"Assay of blood\/uric acid","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84550","description":"Assay of blood\/uric acid","allowed_amounts":[{"tin":{"type":"ein","value":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1912939703]},{"billed_charge":352.00,"npi":[1912939703]}]}]}]},{"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":"250965414"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":17.15,"providers":[{"billed_charge":70.00,"npi":[1821015462]}]}]}]},{"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":"520890739"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.17,"providers":[{"billed_charge":45.75,"npi":[1245307818]}]}]}]},{"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":97.13,"npi":[1063497451]}]}]}]},{"name":"Assay of somatomedin","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84305","description":"Assay of somatomedin","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27.32,"providers":[{"billed_charge":309.75,"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":47.60,"npi":[1063497451]}]}]}]},{"name":"Automated reticulocyte count","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85045","description":"Automated reticulocyte count","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5.14,"providers":[{"billed_charge":44.10,"npi":[1538144910]}]}]}]},{"name":"Automated reticulocyte count","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85045","description":"Automated reticulocyte count","allowed_amounts":[{"tin":{"type":"ein","value":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":124.00,"npi":[1912939703]}]},{"allowed_amount":86.80,"providers":[{"billed_charge":124.00,"npi":[1912939703]}]}]}]},{"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":"251403958"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.01,"providers":[{"billed_charge":0.01,"npi":[1306846035]}]}]}]},{"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":"522315129"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1316508773,1467554097,1740283241]}]}]}]},{"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":"522112078"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.56,"providers":[{"billed_charge":30.00,"npi":[1881361103]}]}]}]},{"name":"Chorionic gonadotropin test","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84702","description":"Chorionic gonadotropin test","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19.34,"providers":[{"billed_charge":114.00,"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.99,"providers":[{"billed_charge":32.55,"npi":[1538144910]}]}]}]},{"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":"520890739"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.81,"providers":[{"billed_charge":54.65,"npi":[1245307818]}]}]}]},{"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":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":235.00,"npi":[1912939703]}]},{"allowed_amount":164.50,"providers":[{"billed_charge":235.00,"npi":[1912939703]}]}]}]},{"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":"596001321"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":32.84,"providers":[{"billed_charge":51.00,"npi":[1538108725]}]}]}]},{"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":"250965414"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":15.84,"providers":[{"billed_charge":60.00,"npi":[1821015462]}]}]}]},{"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":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":543.20,"providers":[{"billed_charge":776.00,"npi":[1912939703]}]},{"allowed_amount":1297.00,"providers":[{"billed_charge":776.00,"npi":[1912939703]}]}]}]},{"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":"596001321"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":45.72,"providers":[{"billed_charge":71.00,"npi":[1538108725]}]}]}]},{"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":[1538144910]}]}]}]},{"name":"Culture screen only","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87081","description":"Culture screen only","allowed_amounts":[{"tin":{"type":"ein","value":"510067938"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":15.86,"providers":[{"billed_charge":163.00,"npi":[1821196486]}]}]}]},{"name":"Culture screen only","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87081","description":"Culture screen only","allowed_amounts":[{"tin":{"type":"ein","value":"520890739"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.37,"providers":[{"billed_charge":193.23,"npi":[1245307818]}]}]}]},{"name":"Destruct b9 lesion 1-14","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17110","description":"Destruct b9 lesion 1-14","allowed_amounts":[{"tin":{"type":"ein","value":"521778640"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":109.92,"providers":[{"billed_charge":300.00,"npi":[1871046045]}]}]}]},{"name":"Dexamethasone sodium phos","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1100","description":"Dexamethasone sodium phos","allowed_amounts":[{"tin":{"type":"ein","value":"540506332"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":6.84,"providers":[{"billed_charge":9.50,"npi":[1033102942]}]}]}]},{"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":"522315129"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1467554097,1740283241]}]}]}]},{"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":"520890739"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":78.46,"providers":[{"billed_charge":118.32,"npi":[1245307818]}]}]}]},{"name":"Drugs unclassified injection","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J3490","description":"Drugs unclassified injection","allowed_amounts":[{"tin":{"type":"ein","value":"540506332"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":13.68,"providers":[{"billed_charge":19.00,"npi":[1033102942]}]},{"allowed_amount":87.12,"providers":[{"billed_charge":121.00,"npi":[1033102942]}]}]}]},{"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":"161395906"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":188.21,"providers":[{"billed_charge":452.03,"npi":[1477134849]}]}]}]},{"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":[1720747223]}]}]}]},{"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":"510381623"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":143.82,"providers":[{"billed_charge":887.00,"npi":[1366797441]}]}]}]},{"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":"530196580"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":389.10,"providers":[{"billed_charge":608.00,"npi":[1356429294]}]}]}]},{"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":"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":"250965414"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":14.57,"providers":[{"billed_charge":50.00,"npi":[1821015462]}]}]}]},{"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":"232514298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":720.00,"providers":[{"billed_charge":800.00,"npi":[1811996283]}]}]}]},{"name":"Hepatic function panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80076","description":"Hepatic function panel","allowed_amounts":[{"tin":{"type":"ein","value":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":472.00,"npi":[1912939703]}]}]}]},{"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":"540506332"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":13.68,"providers":[{"billed_charge":19.00,"npi":[1033102942]}]}]}]},{"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":"520890739"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.04,"providers":[{"billed_charge":61.73,"npi":[1245307818]}]}]}]},{"name":"Lactate (ld) (ldh) enzyme","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83615","description":"Lactate (ld) (ldh) enzyme","allowed_amounts":[{"tin":{"type":"ein","value":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":336.00,"npi":[1912939703]}]}]}]},{"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":"250965414"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":20.09,"providers":[{"billed_charge":71.00,"npi":[1821015462]}]}]}]},{"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":"161165049"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":87.34,"providers":[{"billed_charge":318.00,"npi":[1518998699]}]}]}]},{"name":"Metabolic panel total ca","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80048","description":"Metabolic panel total ca","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.88,"providers":[{"billed_charge":43.94,"npi":[1063497451]}]}]}]},{"name":"Metabolic panel total ca","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80048","description":"Metabolic panel total ca","allowed_amounts":[{"tin":{"type":"ein","value":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":444.00,"npi":[1912939703]}]}]}]},{"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":94.50,"npi":[1538144910]}]}]}]},{"name":"Ob us follow-up per fetus","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76816","description":"Ob us follow-up per fetus","allowed_amounts":[{"tin":{"type":"ein","value":"526049658"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":135.38,"providers":[{"billed_charge":237.00,"npi":[1801843826]}]}]}]},{"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":"251744392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":57.73,"providers":[{"billed_charge":150.00,"npi":[1003566241]}]}]}]},{"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":"251744392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":115.46,"providers":[{"billed_charge":125.00,"npi":[1861498818]}]}]}]},{"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":"593683177"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":71.79,"providers":[{"billed_charge":189.00,"npi":[1932675501]}]}]}]},{"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":"251744392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":162.77,"providers":[{"billed_charge":211.00,"npi":[1003566241]}]}]}]},{"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":"521778640"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":91.56,"providers":[{"billed_charge":250.00,"npi":[1194580233]}]},{"allowed_amount":104.19,"providers":[{"billed_charge":250.00,"npi":[1871046045]}]}]}]},{"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":"522315129"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":152.54,"providers":[{"billed_charge":370.00,"npi":[1316508773]}]}]}]},{"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":"050540625"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":157.97,"providers":[{"billed_charge":350.00,"npi":[1902880560]}]}]}]},{"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":"521778640"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":163.51,"providers":[{"billed_charge":300.00,"npi":[1356504245]}]}]}]},{"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":"540506332"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":3.60,"providers":[{"billed_charge":5.00,"npi":[1033102942]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"161165049"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":1522.49,"providers":[{"billed_charge":5543.00,"npi":[1518998699]}]}]}]},{"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":"251744392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1003566241]}]}]}]},{"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":"161165049"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":16.83,"providers":[{"billed_charge":36.13,"npi":[1386612216]}]}]}]},{"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":[1063497451,1538144910]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"250965414"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":13.64,"providers":[{"billed_charge":8.00,"npi":[1821015462]}]},{"allowed_amount":14.01,"providers":[{"billed_charge":8.00,"npi":[1821015462]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"520890739"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4.17,"providers":[{"billed_charge":38.22,"npi":[1245307818]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"530196580"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":69.00,"npi":[1912939703]}]}]}]},{"name":"Routine venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Routine venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"596001321"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":23.00,"npi":[1538108725]}]}]}]},{"name":"Strep a assay w\/optic","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"87880QW","description":"Strep a assay w\/optic","allowed_amounts":[{"tin":{"type":"ein","value":"521778640"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7.54,"providers":[{"billed_charge":25.00,"npi":[1194580233]}]}]}]},{"name":"Subsequent hospital care","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99232","description":"Subsequent hospital care","allowed_amounts":[{"tin":{"type":"ein","value":"161395906"},"service_code":["21","22"],"billing_class":"professional","payments":[{"allowed_amount":99.04,"providers":[{"billed_charge":181.99,"npi":[1245757392,1396476354,1508123688,1891913232]}]}]}]},{"name":"Syst bp ge 130 - 139mm hg","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3075F","description":"Syst bp ge 130 - 139mm hg","allowed_amounts":[{"tin":{"type":"ein","value":"522315129"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1467554097]}]}]}]},{"name":"Total cortisol","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82533","description":"Total cortisol","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.96,"providers":[{"billed_charge":102.90,"npi":[1063497451]}]}]}]},{"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":[1538144910]}]}]}]},{"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":[1538144910]}]}]}]},{"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":"050540625"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":30.00,"npi":[1902880560]}]}]}]},{"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]}]}]}]}]}
