{"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":"300711211"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4.10,"providers":[{"billed_charge":24.00,"npi":[1861763658]}]}]}]},{"name":"Ambulance Service Basic Life Support\/Emergency","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0429RH","description":"Ambulance Service Basic Life Support\/Emergency","allowed_amounts":[{"tin":{"type":"ein","value":"232840702"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":432.03,"providers":[{"billed_charge":981.25,"npi":[1003819103]}]}]}]},{"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":"316007293"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":521.00,"providers":[{"billed_charge":950.00,"npi":[1609863471]}]}]}]},{"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":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":501.30,"providers":[{"billed_charge":650.00,"npi":[1134131915]}]}]}]},{"name":"Anesthesia","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0370","description":"Anesthesia","allowed_amounts":[{"tin":{"type":"ein","value":"352074283"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":2540.00,"npi":[1336205798]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.59,"providers":[{"billed_charge":122.85,"npi":[1063497451]},{"billed_charge":80.97,"npi":[1063497451]}]}]}]},{"name":"Assay of lipase","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83690","description":"Assay of lipase","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":11.95,"providers":[{"billed_charge":31.37,"npi":[1396714663]}]}]}]},{"name":"Assay of magnesium","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83735","description":"Assay of magnesium","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":11.62,"providers":[{"billed_charge":30.50,"npi":[1396714663]}]}]}]},{"name":"Assay of magnesium","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83735","description":"Assay of magnesium","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":117.00,"npi":[1932589173]}]},{"allowed_amount":56.90,"providers":[{"billed_charge":121.00,"npi":[1932589173]}]},{"allowed_amount":91.49,"providers":[{"billed_charge":117.00,"npi":[1932589173]}]}]}]},{"name":"Assay of natriuretic peptide","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83880","description":"Assay of natriuretic peptide","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":102.44,"providers":[{"billed_charge":131.00,"npi":[1932589173]}]}]}]},{"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 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":"300711211"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3.67,"providers":[{"billed_charge":14.00,"npi":[1861763658]}]}]}]},{"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":"611630276"},"service_code":["11","20","22"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1285617803,1376568600,1407484330,1427381607,1467663856,1922443274]}]}]}]},{"name":"Chemo iv infus each addl seq","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96417","description":"Chemo iv infus each addl seq","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":724.00,"npi":[1932589173]}]},{"allowed_amount":350.80,"providers":[{"billed_charge":746.00,"npi":[1932589173]}]}]}]},{"name":"Chemo iv infusion 1 hr","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96413","description":"Chemo iv infusion 1 hr","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":724.00,"npi":[1932589173]}]},{"allowed_amount":350.80,"providers":[{"billed_charge":746.00,"npi":[1932589173]}]}]}]},{"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":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.17,"providers":[{"billed_charge":40.44,"npi":[1881630614]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":13.48,"providers":[{"billed_charge":35.38,"npi":[1396714663]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":98.00,"npi":[1932589173]}]}]}]},{"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":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.67,"providers":[{"billed_charge":105.79,"npi":[1881630614]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":247.00,"npi":[1932589173]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.06,"providers":[{"billed_charge":86.10,"npi":[1063497451]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":122.95,"npi":[1932589173]}]},{"allowed_amount":61.88,"providers":[{"billed_charge":131.60,"npi":[1932589173]}]}]}]},{"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":"611630276"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1376568600,1922443274]}]}]}]},{"name":"Draw blood off venous device","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36591","description":"Draw blood off venous device","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":152.00,"npi":[1932589173]},{"billed_charge":157.00,"npi":[1932589173]}]},{"allowed_amount":73.83,"providers":[{"billed_charge":157.00,"npi":[1932589173]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":101.01,"providers":[{"billed_charge":265.07,"npi":[1396714663]}]}]}]},{"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":"621113737"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":210.94,"providers":[{"billed_charge":3840.00,"npi":[1023055126]}]}]}]},{"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":"922122433"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":191.45,"providers":[{"billed_charge":678.00,"npi":[1083076145]}]}]}]},{"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":"311116049"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":336.30,"providers":[{"billed_charge":1268.00,"npi":[1811709660]}]}]}]},{"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":"474944608"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":320.47,"providers":[{"billed_charge":2331.00,"npi":[1942200027]}]}]}]},{"name":"Free assay (ft-3)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84481","description":"Free assay (ft-3)","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21.77,"providers":[{"billed_charge":229.95,"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.18,"providers":[{"billed_charge":190.05,"npi":[1063497451]},{"billed_charge":231.93,"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":"352056396"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":311.90,"providers":[{"billed_charge":454.00,"npi":[1356435341]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":517.00,"npi":[1932589173]}]},{"allowed_amount":261.92,"providers":[{"billed_charge":557.00,"npi":[1932589173]}]},{"allowed_amount":423.84,"providers":[{"billed_charge":542.00,"npi":[1932589173]}]}]}]},{"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":"300711211"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.88,"providers":[{"billed_charge":40.00,"npi":[1861763658]}]}]}]},{"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":"232840702"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":82.35,"providers":[{"billed_charge":204.25,"npi":[1003819103]}]}]}]},{"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":"316007293"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":65.00,"providers":[{"billed_charge":80.00,"npi":[1609863471]}]}]}]},{"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":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27.45,"providers":[{"billed_charge":39.00,"npi":[1134131915]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":14.20,"providers":[{"billed_charge":37.27,"npi":[1396714663]}]}]}]},{"name":"Hydrate iv infusion add-on","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96361","description":"Hydrate iv infusion add-on","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":141.00,"providers":[{"billed_charge":370.00,"npi":[1396714663]}]}]}]},{"name":"Inj heparin sodium per 10 u","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1642","description":"Inj heparin sodium per 10 u","allowed_amounts":[{"tin":{"type":"ein","value":"352056396"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":34.00,"npi":[1356435341]}]}]}]},{"name":"Inj heparin sodium per 10 u","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J1642","description":"Inj heparin sodium per 10 u","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":122.25,"npi":[1932589173]},{"billed_charge":124.60,"npi":[1932589173]},{"billed_charge":126.05,"npi":[1932589173]},{"billed_charge":128.20,"npi":[1932589173]},{"billed_charge":129.85,"npi":[1932589173]}]}]}]},{"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":"352056396"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":79.01,"providers":[{"billed_charge":115.00,"npi":[1356435341]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":67.00,"npi":[1932589173]}]},{"allowed_amount":32.45,"providers":[{"billed_charge":69.00,"npi":[1932589173]}]},{"allowed_amount":52.39,"providers":[{"billed_charge":67.00,"npi":[1932589173]}]}]}]},{"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":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.33,"providers":[{"billed_charge":177.90,"npi":[1881630614]}]}]}]},{"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":"352074283"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1554.00,"npi":[1336205798]},{"billed_charge":2676.00,"npi":[1336205798]}]}]}]},{"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":"300711211"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5.99,"providers":[{"billed_charge":42.00,"npi":[1861763658]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":12.17,"providers":[{"billed_charge":31.94,"npi":[1396714663]}]}]}]},{"name":"Normal saline solution infus","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J7030","description":"Normal saline solution infus","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":9.01,"providers":[{"billed_charge":23.64,"npi":[1396714663]}]},{"allowed_amount":18.02,"providers":[{"billed_charge":47.28,"npi":[1396714663]}]}]}]},{"name":"Normal saline solution infus","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J7030","description":"Normal saline solution infus","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":90.05,"npi":[1932589173]},{"billed_charge":97.65,"npi":[1932589173]}]},{"allowed_amount":184.10,"providers":[{"billed_charge":391.50,"npi":[1932589173]}]}]}]},{"name":"Normal saline solution infus","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J7050","description":"Normal saline solution infus","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":100.85,"npi":[1932589173]},{"billed_charge":167.30,"npi":[1932589173]},{"billed_charge":83.65,"npi":[1932589173]}]},{"allowed_amount":97.67,"providers":[{"billed_charge":207.70,"npi":[1932589173]}]}]}]},{"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":"351097674"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":43.88,"providers":[{"billed_charge":59.00,"npi":[1447546031]}]}]}]},{"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":"352056396"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":379.91,"providers":[{"billed_charge":553.00,"npi":[1356435341]}]}]}]},{"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":"464116085"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":90.55,"providers":[{"billed_charge":145.00,"npi":[1134455363]}]}]}]},{"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":"473825106"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":87.24,"providers":[{"billed_charge":98.00,"npi":[1710367966]}]}]}]},{"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":"611630276"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":56.69,"providers":[{"billed_charge":146.00,"npi":[1407484330,1942282215]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921395","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"161097588"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":442.61,"providers":[{"billed_charge":450.00,"npi":[1043405244]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921395","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"462155766"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":65.84,"providers":[{"billed_charge":150.00,"npi":[1578723151]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921395","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"464116085"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":90.55,"providers":[{"billed_charge":145.00,"npi":[1134455363]}]}]}]},{"name":"Office\/outpatient visit est","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921395","description":"Office\/outpatient visit est","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":87.24,"providers":[{"billed_charge":98.00,"npi":[1710367966]}]}]}]},{"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":126.60,"providers":[{"billed_charge":372.00,"npi":[1053572420]}]}]}]},{"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":"464116085"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":128.79,"providers":[{"billed_charge":220.00,"npi":[1134455363]}]}]}]},{"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":"593360315"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":111.76,"providers":[{"billed_charge":338.00,"npi":[1316979529]}]}]}]},{"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":"611630276"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":91.35,"providers":[{"billed_charge":204.00,"npi":[1376568600,1922443274]}]}]},{"tin":{"type":"ein","value":"611630276"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":65.17,"providers":[{"billed_charge":204.00,"npi":[1285617803,1427381607]}]}]}]},{"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":"161097588"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":623.32,"providers":[{"billed_charge":635.00,"npi":[1043405244]}]}]}]},{"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":"611630276"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":105.11,"providers":[{"billed_charge":287.00,"npi":[1467663856]}]}]}]},{"name":"Oxygen concentrator","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1390RR","description":"Oxygen concentrator","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":78.66,"providers":[{"billed_charge":78.66,"npi":[1477222834]}]}]}]},{"name":"Palonosetron hcl","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"J2469","description":"Palonosetron hcl","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":161.95,"npi":[1932589173]}]},{"allowed_amount":78.06,"providers":[{"billed_charge":166.00,"npi":[1932589173]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":13.29,"providers":[{"billed_charge":34.88,"npi":[1396714663]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"352074283"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":6884.70,"npi":[1336205798]},{"billed_charge":9952.15,"npi":[1336205798]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":103.54,"providers":[{"billed_charge":132.40,"npi":[1932589173]}]},{"allowed_amount":105.34,"providers":[{"billed_charge":134.70,"npi":[1932589173]}]},{"allowed_amount":107.06,"providers":[{"billed_charge":136.90,"npi":[1932589173]}]},{"allowed_amount":540.05,"providers":[{"billed_charge":1148.45,"npi":[1932589173]}]},{"allowed_amount":101673.83,"providers":[{"billed_charge":134.80,"npi":[1932589173]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"621113737"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":3.48,"providers":[{"billed_charge":63.28,"npi":[1023055126]}]}]}]},{"name":"Pharmacy - iv solutions","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0258","description":"Pharmacy - iv solutions","allowed_amounts":[{"tin":{"type":"ein","value":"352074283"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":924.25,"npi":[1336205798]},{"billed_charge":976.15,"npi":[1336205798]}]}]}]},{"name":"Portable oxygen concentrator","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"E1392RR","description":"Portable oxygen concentrator","allowed_amounts":[{"tin":{"type":"ein","value":"202536458"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":37.78,"providers":[{"billed_charge":37.78,"npi":[1477222834]}]}]}]},{"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":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":16.73,"providers":[{"billed_charge":216.00,"npi":[1114135100]}]},{"allowed_amount":17.74,"providers":[{"billed_charge":216.00,"npi":[1114135100]}]},{"allowed_amount":19.77,"providers":[{"billed_charge":216.00,"npi":[1114135100,1821009440]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":12.30,"npi":[1396714663]}]},{"allowed_amount":4.69,"providers":[{"billed_charge":12.30,"npi":[1396714663]}]}]}]},{"name":"Self care mngment training","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97535","description":"Self care mngment training","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":97.75,"providers":[{"billed_charge":125.00,"npi":[1932589173]}]}]}]},{"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":"611630276"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1376568600]}]}]}]},{"name":"Ther\/Proph\/Diag Inj, Iv Push","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"96374XU","description":"Ther\/Proph\/Diag Inj, Iv Push","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":123.85,"providers":[{"billed_charge":325.00,"npi":[1396714663]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":121.21,"providers":[{"billed_charge":155.00,"npi":[1932589173]}]}]}]},{"name":"Therapeutic Exercises","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"97110GO","description":"Therapeutic Exercises","allowed_amounts":[{"tin":{"type":"ein","value":"251721021"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":94.92,"providers":[{"billed_charge":237.30,"npi":[1316996887]}]}]}]},{"name":"Therapeutic exercises","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97110","description":"Therapeutic exercises","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":340.17,"providers":[{"billed_charge":435.00,"npi":[1932589173]}]}]}]},{"name":"Total cortisol","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82533","description":"Total cortisol","allowed_amounts":[{"tin":{"type":"ein","value":"352056396"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":177.25,"providers":[{"billed_charge":258.00,"npi":[1356435341]}]}]}]},{"name":"Total cortisol","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82533","description":"Total cortisol","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":278.00,"npi":[1932589173]}]},{"allowed_amount":134.49,"providers":[{"billed_charge":286.00,"npi":[1932589173]}]},{"allowed_amount":217.40,"providers":[{"billed_charge":278.00,"npi":[1932589173]}]}]}]},{"name":"Tx\/pro\/dx inj new drug addon","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","description":"Tx\/pro\/dx inj new drug addon","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":209.60,"providers":[{"billed_charge":550.00,"npi":[1396714663]}]}]}]},{"name":"Tx\/pro\/dx inj new drug addon","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","description":"Tx\/pro\/dx inj new drug addon","allowed_amounts":[{"tin":{"type":"ein","value":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":150.00,"npi":[1932589173]}]},{"allowed_amount":72.89,"providers":[{"billed_charge":155.00,"npi":[1932589173]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":5.50,"providers":[{"billed_charge":14.43,"npi":[1396714663]}]}]}]},{"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":"473825106"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":36.00,"providers":[{"billed_charge":82.00,"npi":[1932589173]}]}]}]},{"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":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":14.02,"providers":[{"billed_charge":36.78,"npi":[1396714663]}]}]}]},{"name":"Urine pregnancy test","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81025","description":"Urine pregnancy test","allowed_amounts":[{"tin":{"type":"ein","value":"310537122"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":13.45,"providers":[{"billed_charge":35.30,"npi":[1396714663]}]}]}]},{"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":"611630276"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":30.00,"npi":[1427381607,1467663856]}]}]}]},{"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]}]}]}]}]}
