{
  "reporting_entity_name": "AMPS",
  "reporting_entity_type": "third party",
  "last_updated_on": "2026-05-26",
  "version": "v2.1.0",
  "out_of_network": [
    {
      "name": "Comprehen metabolic panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "80053",
      "description": "Comprehen metabolic panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 10.56,
              "providers": [
                {
                  "billed_charge": 48.3,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Lipid panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "80061",
      "description": "Lipid panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 13.39,
              "providers": [
                {
                  "billed_charge": 97.65,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Vitamin d 25 hydroxy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "82306",
      "description": "Vitamin d 25 hydroxy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 29.6,
              "providers": [
                {
                  "billed_charge": 248.63,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of ceruloplasmin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "82390",
      "description": "Assay of ceruloplasmin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 10.74,
              "providers": [
                {
                  "billed_charge": 81.68,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of copper",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "82525",
      "description": "Assay of copper",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 12.41,
              "providers": [
                {
                  "billed_charge": 107.93,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of ferritin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "82728",
      "description": "Assay of ferritin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 13.63,
              "providers": [
                {
                  "billed_charge": 87.98,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Glycosylated hemoglobin test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "83036",
      "description": "Glycosylated hemoglobin test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 9.71,
              "providers": [
                {
                  "billed_charge": 69.3,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of iron",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "83540",
      "description": "Assay of iron",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 6.47,
              "providers": [
                {
                  "billed_charge": 38.55,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of transferrin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "84466",
      "description": "Assay of transferrin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 12.76,
              "providers": [
                {
                  "billed_charge": 71.11,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of zinc",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "84630",
      "description": "Assay of zinc",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.39,
              "providers": [
                {
                  "billed_charge": 100.58,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Complete cbc w/auto diff wbc",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "85025",
      "description": "Complete cbc w/auto diff wbc",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 7.77,
              "providers": [
                {
                  "billed_charge": 35.065,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Phlebotomy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "99195",
      "description": "Phlebotomy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200984494"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 108.32,
              "providers": [
                {
                  "billed_charge": 200,
                  "npi": [
                    1629037270
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-05-26",
      "billing_code": "99214",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200984494"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 149.06,
              "providers": [
                {
                  "billed_charge": 235,
                  "npi": [
                    1629037270
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    }
  ]
}