{
  "reporting_entity_name": "AMPS",
  "reporting_entity_type": "third party",
  "last_updated_on": "2026-07-26",
  "version": "v2.1.0",
  "out_of_network": [
    {
      "name": "MED: DIABETES W MCC",
      "billing_code_type": "MS-DRG",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "637",
      "description": "MED: DIABETES W MCC",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 35196.75,
              "providers": [
                {
                  "billed_charge": 202520.72,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "00918  Anesthesia, stone removal",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "00918",
      "description": "00918  Anesthesia, stone removal",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 2156.18,
              "providers": [
                {
                  "billed_charge": 2156.18,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Bx breast 1st lesion us imag",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "19083",
      "description": "Bx breast 1st lesion us imag",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 199.64,
              "providers": [
                {
                  "billed_charge": 3886.76,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Needle biopsy lymph nodes",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "38505",
      "description": "Needle biopsy lymph nodes",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 2750,
              "providers": [
                {
                  "billed_charge": 2750,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Cysto w/ureter stricture tx",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "52341",
      "description": "Cysto w/ureter stricture tx",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 5764.51,
              "providers": [
                {
                  "billed_charge": 5764.51,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Cysto/uretero w/lithotripsy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "52356",
      "description": "Cysto/uretero w/lithotripsy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 5764.52,
              "providers": [
                {
                  "billed_charge": 5764.52,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct head/brain w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "70450",
      "description": "Ct head/brain w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 52.41,
              "providers": [
                {
                  "billed_charge": 182,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "Mri brain stem w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "70551",
      "description": "Mri brain stem w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 90.07,
              "providers": [
                {
                  "billed_charge": 317,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "Mri brain stem w/o & w/dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "70553",
      "description": "Mri brain stem w/o & w/dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 139.9,
              "providers": [
                {
                  "billed_charge": 507,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam chest 1 view",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "71045",
      "description": "X-ray exam chest 1 view",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.11,
              "providers": [
                {
                  "billed_charge": 39,
                  "npi": [
                    1457339277
                  ]
                },
                {
                  "billed_charge": 39,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam chest 2 views",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "71046",
      "description": "X-ray exam chest 2 views",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 332.38,
              "providers": [
                {
                  "billed_charge": 332.38,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct thorax w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "71250",
      "description": "Ct thorax w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 65.72,
              "providers": [
                {
                  "billed_charge": 221,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam neck spine 4/5vws",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "72050",
      "description": "X-ray exam neck spine 4/5vws",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311340739"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 595,
              "providers": [
                {
                  "billed_charge": 595,
                  "npi": [
                    1447359997
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct neck spine w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "72125",
      "description": "Ct neck spine w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 61.78,
              "providers": [
                {
                  "billed_charge": 230,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "Ct chest spine w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "72128",
      "description": "Ct chest spine w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 61.78,
              "providers": [
                {
                  "billed_charge": 216,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "Ct lumbar spine w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "72131",
      "description": "Ct lumbar spine w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 61.78,
              "providers": [
                {
                  "billed_charge": 216,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "Mri neck spine w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "72141",
      "description": "Mri neck spine w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311340739"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 267.95,
              "providers": [
                {
                  "billed_charge": 2064,
                  "npi": [
                    1447359997
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "X-ray exam abdomen 1 view",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "74018",
      "description": "X-ray exam abdomen 1 view",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.5,
              "providers": [
                {
                  "billed_charge": 39,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam abdomen 2 views",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "74019",
      "description": "X-ray exam abdomen 2 views",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 14.09,
              "providers": [
                {
                  "billed_charge": 50,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Ct abd & pelvis w/o contrast",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "74176",
      "description": "Ct abd & pelvis w/o contrast",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 2656.19,
              "providers": [
                {
                  "billed_charge": 2656.19,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            },
            {
              "allowed_amount": 105.98,
              "providers": [
                {
                  "billed_charge": 368,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct abd & pelv w/contrast",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "74177",
      "description": "Ct abd & pelv w/contrast",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 111.59,
              "providers": [
                {
                  "billed_charge": 384,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Cine/vid x-ray throat/esoph",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "74230",
      "description": "Cine/vid x-ray throat/esoph",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550493376"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 32.83,
              "providers": [
                {
                  "billed_charge": 114,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Contrst x-ray urinary tract",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "74420",
      "description": "Contrst x-ray urinary tract",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 965.13,
              "providers": [
                {
                  "billed_charge": 965.13,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ultrasound breast complete",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "76641",
      "description": "Ultrasound breast complete",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 184.52,
              "providers": [
                {
                  "billed_charge": 518,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Ultrasound breast limited",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "76642",
      "description": "Ultrasound breast limited",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 103.13,
              "providers": [
                {
                  "billed_charge": 150,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            },
            {
              "allowed_amount": 41.43,
              "providers": [
                {
                  "billed_charge": 137,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Us exam abdom complete",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "76700",
      "description": "Us exam abdom complete",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 140.2,
              "providers": [
                {
                  "billed_charge": 294,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Echo exam of abdomen",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "76705",
      "description": "Echo exam of abdomen",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1363.91,
              "providers": [
                {
                  "billed_charge": 1363.91,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Breast tomosynthesis uni",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "77061",
      "description": "Breast tomosynthesis uni",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 51.66,
              "providers": [
                {
                  "billed_charge": 75,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Breast tomosynthesis bi",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "77063",
      "description": "Breast tomosynthesis bi",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 30.12,
              "providers": [
                {
                  "billed_charge": 40.85,
                  "npi": [
                    1073518007
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            },
            {
              "allowed_amount": 61,
              "providers": [
                {
                  "billed_charge": 61,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Dx mammo incl cad uni",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "77065",
      "description": "Dx mammo incl cad uni",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 112.6,
              "providers": [
                {
                  "billed_charge": 308.24,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 151.56,
              "providers": [
                {
                  "billed_charge": 240,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            },
            {
              "allowed_amount": 50.21,
              "providers": [
                {
                  "billed_charge": 174,
                  "npi": [
                    1457339277
                  ]
                },
                {
                  "billed_charge": 174,
                  "npi": [
                    1457339277
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Scr mammo bi incl cad",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "77067",
      "description": "Scr mammo bi incl cad",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 116.09,
              "providers": [
                {
                  "billed_charge": 433.42,
                  "npi": [
                    1073518007
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            },
            {
              "allowed_amount": 153.75,
              "providers": [
                {
                  "billed_charge": 290,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Metabolic panel total ca",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "80048",
      "description": "Metabolic panel total ca",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 144.7,
              "providers": [
                {
                  "billed_charge": 144.7,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            },
            {
              "allowed_amount": 8.46,
              "providers": [
                {
                  "billed_charge": 33.62,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Comprehen metabolic panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "80053",
      "description": "Comprehen metabolic panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 211.06,
              "providers": [
                {
                  "billed_charge": 211.06,
                  "npi": [
                    1215936927
                  ]
                }
              ],
              "billing_code_modifier": [
                "QW"
              ]
            },
            {
              "allowed_amount": 15.84,
              "providers": [
                {
                  "billed_charge": 330.58,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 10.56,
              "providers": [
                {
                  "billed_charge": 50.39666666666667,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Lipid panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "80061",
      "description": "Lipid panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 20.09,
              "providers": [
                {
                  "billed_charge": 122.54,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 13.39,
              "providers": [
                {
                  "billed_charge": 94.08142857142857,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Acute hepatitis panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "80074",
      "description": "Acute hepatitis panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 47.63,
              "providers": [
                {
                  "billed_charge": 391.65,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Hepatic function panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "80076",
      "description": "Hepatic function panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.17,
              "providers": [
                {
                  "billed_charge": 43.05,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Drug scrn quant oxcarbazepin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "80183",
      "description": "Drug scrn quant oxcarbazepin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 13.25,
              "providers": [
                {
                  "billed_charge": 155.4,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Urinalysis auto w/scope",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "81001",
      "description": "Urinalysis auto w/scope",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 55.85,
              "providers": [
                {
                  "billed_charge": 55.85,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ur albumin quantitative",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82043",
      "description": "Ur albumin quantitative",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5.78,
              "providers": [
                {
                  "billed_charge": 71.35,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of amylase",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82150",
      "description": "Assay of amylase",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 6.48,
              "providers": [
                {
                  "billed_charge": 49.88,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Bilirubin direct",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82248",
      "description": "Bilirubin direct",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5.02,
              "providers": [
                {
                  "billed_charge": 5.81,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Vitamin d 25 hydroxy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82306",
      "description": "Vitamin d 25 hydroxy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 44.4,
              "providers": [
                {
                  "billed_charge": 354.67,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 29.6,
              "providers": [
                {
                  "billed_charge": 199.98333333333332,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Calculus spectroscopy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82365",
      "description": "Calculus spectroscopy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 76.22,
              "providers": [
                {
                  "billed_charge": 76.22,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Total cortisol",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82533",
      "description": "Total cortisol",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 24.45,
              "providers": [
                {
                  "billed_charge": 364.08,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of creatinine",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82565",
      "description": "Assay of creatinine",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 2.56,
              "providers": [
                {
                  "billed_charge": 38.85,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of urine creatinine",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82570",
      "description": "Assay of urine creatinine",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5.18,
              "providers": [
                {
                  "billed_charge": 59.405,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Vitamin b-12",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82607",
      "description": "Vitamin b-12",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 22.62,
              "providers": [
                {
                  "billed_charge": 170.43,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 15.08,
              "providers": [
                {
                  "billed_charge": 79.816,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of ferritin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "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": 81.392,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of folic acid serum",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "82746",
      "description": "Assay of folic acid serum",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 14.7,
              "providers": [
                {
                  "billed_charge": 87.37,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Glycosylated hemoglobin test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "83036",
      "description": "Glycosylated hemoglobin test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 14.57,
              "providers": [
                {
                  "billed_charge": 173.08,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 9.71,
              "providers": [
                {
                  "billed_charge": 54.17333333333333,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of iron",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "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": 33.736,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Iron binding test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "83550",
      "description": "Iron binding test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.74,
              "providers": [
                {
                  "billed_charge": 50.486,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of lipase",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "83690",
      "description": "Assay of lipase",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 106.42,
              "providers": [
                {
                  "billed_charge": 106.42,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            },
            {
              "allowed_amount": 6.89,
              "providers": [
                {
                  "billed_charge": 53.02,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of protein urine",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "84156",
      "description": "Assay of protein urine",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 3.67,
              "providers": [
                {
                  "billed_charge": 38.74,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of free thyroxine",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "84439",
      "description": "Assay of free thyroxine",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 13.53,
              "providers": [
                {
                  "billed_charge": 104.91,
                  "npi": [
                    1073518007
                  ]
                },
                {
                  "billed_charge": 153.2,
                  "npi": [
                    1851346720
                  ]
                }
              ]
            },
            {
              "allowed_amount": 9.02,
              "providers": [
                {
                  "billed_charge": 71.15333333333334,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay thyroid stim hormone",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "84443",
      "description": "Assay thyroid stim hormone",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 25.2,
              "providers": [
                {
                  "billed_charge": 257.41,
                  "npi": [
                    1073518007
                  ]
                },
                {
                  "billed_charge": 192.38,
                  "npi": [
                    1851346720
                  ]
                }
              ]
            },
            {
              "allowed_amount": 16.8,
              "providers": [
                {
                  "billed_charge": 99.06571428571428,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of blood/uric acid",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "84550",
      "description": "Assay of blood/uric acid",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 4.52,
              "providers": [
                {
                  "billed_charge": 21.28,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Hematocrit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "85014",
      "description": "Hematocrit",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 2.37,
              "providers": [
                {
                  "billed_charge": 30.97,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Hemoglobin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "85018",
      "description": "Hemoglobin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 2.37,
              "providers": [
                {
                  "billed_charge": 30.97,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Complete cbc w/auto diff wbc",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "85025",
      "description": "Complete cbc w/auto diff wbc",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 79.24,
              "providers": [
                {
                  "billed_charge": 79.24,
                  "npi": [
                    1215936927
                  ]
                }
              ],
              "billing_code_modifier": [
                "QW"
              ]
            },
            {
              "allowed_amount": 11.66,
              "providers": [
                {
                  "billed_charge": 112.25,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 7.77,
              "providers": [
                {
                  "billed_charge": 35.31428571428572,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Complete cbc automated",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "85027",
      "description": "Complete cbc automated",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 79.24,
              "providers": [
                {
                  "billed_charge": 79.24,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            },
            {
              "allowed_amount": 9.71,
              "providers": [
                {
                  "billed_charge": 95.8,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 6.47,
              "providers": [
                {
                  "billed_charge": 32.23,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Automated reticulocyte count",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "85045",
      "description": "Automated reticulocyte count",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 3.99,
              "providers": [
                {
                  "billed_charge": 23.6975,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Rbc sed rate automated",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "85652",
      "description": "Rbc sed rate automated",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 1.8,
              "providers": [
                {
                  "billed_charge": 37.8,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "C-reactive protein",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "86140",
      "description": "C-reactive protein",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 3.453333333333333,
              "providers": [
                {
                  "billed_charge": 71.4,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Microsomal antibody each",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "86376",
      "description": "Microsomal antibody each",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 14.55,
              "providers": [
                {
                  "billed_charge": 93.29,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Tb test cell immun measure",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "86480",
      "description": "Tb test cell immun measure",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 61.98,
              "providers": [
                {
                  "billed_charge": 238.35,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Thyroglobulin antibody",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "86800",
      "description": "Thyroglobulin antibody",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 15.91,
              "providers": [
                {
                  "billed_charge": 102.01,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Culture aerobic identify",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87077",
      "description": "Culture aerobic identify",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.08,
              "providers": [
                {
                  "billed_charge": 19.685,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Urine culture/colony count",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87086",
      "description": "Urine culture/colony count",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 113.2,
              "providers": [
                {
                  "billed_charge": 113.2,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            },
            {
              "allowed_amount": 12.11,
              "providers": [
                {
                  "billed_charge": 147.52,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 8.07,
              "providers": [
                {
                  "billed_charge": 38.11333333333334,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Urine bacteria culture",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87088",
      "description": "Urine bacteria culture",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.09,
              "providers": [
                {
                  "billed_charge": 19.725,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Microbe susceptible mic",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87186",
      "description": "Microbe susceptible mic",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.65,
              "providers": [
                {
                  "billed_charge": 63.45,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Strep a ag ia",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87430",
      "description": "Strep a ag ia",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 16.81,
              "providers": [
                {
                  "billed_charge": 44,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Lyme dis dna amp probe",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87476",
      "description": "Lyme dis dna amp probe",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 35.09,
              "providers": [
                {
                  "billed_charge": 619.5,
                  "npi": [
                    1932184322
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Iadna-dna/rna probe tq 12-25",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87507",
      "description": "Iadna-dna/rna probe tq 12-25",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 416.78,
              "providers": [
                {
                  "billed_charge": 819,
                  "npi": [
                    1538144910
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Hpv high-risk types",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "87624",
      "description": "Hpv high-risk types",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 230.68,
              "providers": [
                {
                  "billed_charge": 230.68,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Cytopath c/v auto fluid redo",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "88175",
      "description": "Cytopath c/v auto fluid redo",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 26.61,
              "providers": [
                {
                  "billed_charge": 55,
                  "npi": [
                    1891770806
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Tissue exam by pathologist",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "88304",
      "description": "Tissue exam by pathologist",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "133757370"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 77.4,
              "providers": [
                {
                  "billed_charge": 172,
                  "npi": [
                    1417245176
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Tissue exam by pathologist",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "88305",
      "description": "Tissue exam by pathologist",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 139.215,
              "providers": [
                {
                  "billed_charge": 232.44,
                  "npi": [
                    1073518007
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            },
            {
              "allowed_amount": 929.76,
              "providers": [
                {
                  "billed_charge": 929.76,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            },
            {
              "allowed_amount": 67.94,
              "providers": [
                {
                  "billed_charge": 203.8,
                  "npi": [
                    1003863580
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Immunohisto antb addl slide",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "88341",
      "description": "Immunohisto antb addl slide",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 336.45,
              "providers": [
                {
                  "billed_charge": 336.45,
                  "npi": [
                    1073518007
                  ]
                },
                {
                  "billed_charge": 336.45,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Immunohisto antb 1st stain",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "88342",
      "description": "Immunohisto antb 1st stain",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 336.45,
              "providers": [
                {
                  "billed_charge": 336.45,
                  "npi": [
                    1073518007
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Microdissection manual",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "88381",
      "description": "Microdissection manual",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 350,
              "providers": [
                {
                  "billed_charge": 350,
                  "npi": [
                    1073518007
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Psytx w pt 45 minutes",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "90834",
      "description": "Psytx w pt 45 minutes",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 138.19,
              "providers": [
                {
                  "billed_charge": 192,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Psytx w pt 60 minutes",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "90837",
      "description": "Psytx w pt 60 minutes",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 202.55,
              "providers": [
                {
                  "billed_charge": 282,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Electrocardiogram complete",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "93000",
      "description": "Electrocardiogram complete",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 20.26,
              "providers": [
                {
                  "billed_charge": 100,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Electrocardiogram tracing",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "93005",
      "description": "Electrocardiogram tracing",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 9.42,
              "providers": [
                {
                  "billed_charge": 251.83,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Musc test done w/n test comp",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "95886",
      "description": "Musc test done w/n test comp",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311340739"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 281.16,
              "providers": [
                {
                  "billed_charge": 556,
                  "npi": [
                    1447359997
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Nrv cndj test 11-12 studies",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "95912",
      "description": "Nrv cndj test 11-12 studies",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311340739"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 362.46,
              "providers": [
                {
                  "billed_charge": 1403,
                  "npi": [
                    1447359997
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Brief emotional/behav assmt",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "96127",
      "description": "Brief emotional/behav assmt",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5,
              "providers": [
                {
                  "billed_charge": 5,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "99212",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310983140"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 45.87,
              "providers": [
                {
                  "billed_charge": 315.66,
                  "npi": [
                    1598868655
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "99213",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 86.75333333333333,
              "providers": [
                {
                  "billed_charge": 169,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "99214",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 161.09,
              "providers": [
                {
                  "billed_charge": 238,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Subsequent hospital care",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "99232",
      "description": "Subsequent hospital care",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 88.06,
              "providers": [
                {
                  "billed_charge": 144.29,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Emergency dept visit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "99285",
      "description": "Emergency dept visit",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 2795.76,
              "providers": [
                {
                  "billed_charge": 2795.76,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Infusion supplies with pump",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "A4222",
      "description": "Infusion supplies with pump",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 27.85,
              "providers": [
                {
                  "billed_charge": 27.85,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "C1726  -  CATHETER, non-vascular, balloon dil",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "C1726",
      "description": "C1726  -  CATHETER, non-vascular, balloon dil",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 596.84,
              "providers": [
                {
                  "billed_charge": 596.84,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "C1758 - Catheter Ureteral (not urethral)",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "C1758",
      "description": "C1758 - Catheter Ureteral (not urethral)",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 40.26,
              "providers": [
                {
                  "billed_charge": 40.26,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Colorectal scrn; hi risk ind",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "G0105",
      "description": "Colorectal scrn; hi risk ind",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 247.07,
              "providers": [
                {
                  "billed_charge": 5784.73,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Scr c/v cyto,thinlayer,rescr",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "G0145",
      "description": "Scr c/v cyto,thinlayer,rescr",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 212.16,
              "providers": [
                {
                  "billed_charge": 212.16,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Hospital observation per hr",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "G0378",
      "description": "Hospital observation per hr",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1368.82,
              "providers": [
                {
                  "billed_charge": 1368.82,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Hospital outpt clinic visit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "G0463",
      "description": "Hospital outpt clinic visit",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 103.335,
              "providers": [
                {
                  "billed_charge": 118,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Dexamethasone sodium phos",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "J1100",
      "description": "Dexamethasone sodium phos",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550490878"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 0.15,
              "providers": [
                {
                  "billed_charge": 9,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Ketorolac tromethamine inj",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "J1885",
      "description": "Ketorolac tromethamine inj",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "314379509"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 11.89,
              "providers": [
                {
                  "billed_charge": 11.89,
                  "npi": [
                    1215936927
                  ]
                }
              ]
            },
            {
              "allowed_amount": 0.225,
              "providers": [
                {
                  "billed_charge": 3,
                  "npi": [
                    1588738538
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Inj, propofol, 10 mg",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "J2704",
      "description": "Inj, propofol, 10 mg",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550675666"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 6.75,
              "providers": [
                {
                  "billed_charge": 105.65,
                  "npi": [
                    1073518007
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Clinic service",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-07-26",
      "billing_code": "T1015",
      "description": "Clinic service",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "550372580"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 107.89,
              "providers": [
                {
                  "billed_charge": 107.89,
                  "npi": [
                    1619913647
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}