{
  "reporting_entity_name": "AMPS",
  "reporting_entity_type": "third party",
  "last_updated_on": "2026-09-26",
  "version": "v2.1.0",
  "out_of_network": [
    {
      "name": "Ct head/brain w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "70450",
      "description": "Ct head/brain w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "591226176"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 51.05,
              "providers": [
                {
                  "billed_charge": 733,
                  "npi": [
                    1093782070
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam of lower leg",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "73590",
      "description": "X-ray exam of lower leg",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "590724459"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 763,
              "providers": [
                {
                  "billed_charge": 763,
                  "npi": [
                    1306938071
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ht muscle image spect mult",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "78452",
      "description": "Ht muscle image spect mult",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "593140335"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 558.55,
              "providers": [
                {
                  "billed_charge": 1036,
                  "npi": [
                    1043269871
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "General health panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "80050",
      "description": "General health panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 35,
              "providers": [
                {
                  "billed_charge": 317.18,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Lipid panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "80061",
      "description": "Lipid panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 13.39,
              "providers": [
                {
                  "billed_charge": 177.9,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of calcium",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "82310",
      "description": "Assay of calcium",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "590774199"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 6.71,
              "providers": [
                {
                  "billed_charge": 25,
                  "npi": [
                    1881632818
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of estradiol",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "82670",
      "description": "Assay of estradiol",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 27.94,
              "providers": [
                {
                  "billed_charge": 268.89,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of gonadotropin (fsh)",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "83001",
      "description": "Assay of gonadotropin (fsh)",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 18.58,
              "providers": [
                {
                  "billed_charge": 162.14,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of gonadotropin (lh)",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "83002",
      "description": "Assay of gonadotropin (lh)",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 18.52,
              "providers": [
                {
                  "billed_charge": 162.14,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Glycosylated hemoglobin test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "83036",
      "description": "Glycosylated hemoglobin test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 9.71,
              "providers": [
                {
                  "billed_charge": 89.2,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of parathormone",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "83970",
      "description": "Assay of parathormone",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "590774199"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 53.66,
              "providers": [
                {
                  "billed_charge": 156,
                  "npi": [
                    1881632818
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of progesterone",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "84144",
      "description": "Assay of progesterone",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 20.86,
              "providers": [
                {
                  "billed_charge": 154.02,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of sex hormone globul",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "84270",
      "description": "Assay of sex hormone globul",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 21.73,
              "providers": [
                {
                  "billed_charge": 166.2,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of free testosterone",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "84402",
      "description": "Assay of free testosterone",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 25.47,
              "providers": [
                {
                  "billed_charge": 169.09,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of total testosterone",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "84403",
      "description": "Assay of total testosterone",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 25.81,
              "providers": [
                {
                  "billed_charge": 171.4,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Culture aerobic identify",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "87077",
      "description": "Culture aerobic identify",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.08,
              "providers": [
                {
                  "billed_charge": 39.19,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Urine culture/colony count",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "87086",
      "description": "Urine culture/colony count",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.07,
              "providers": [
                {
                  "billed_charge": 72.98,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Urine bacteria culture",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "87088",
      "description": "Urine bacteria culture",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.09,
              "providers": [
                {
                  "billed_charge": 39.19,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Microbe susceptible mic",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "87186",
      "description": "Microbe susceptible mic",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "382084239"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.65,
              "providers": [
                {
                  "billed_charge": 85.13,
                  "npi": [
                    1932166386
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Tissue exam by pathologist",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "88305",
      "description": "Tissue exam by pathologist",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "591723249"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 222.59,
              "providers": [
                {
                  "billed_charge": 880,
                  "npi": [
                    1790732360
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "22"
          ]
        }
      ]
    },
    {
      "name": "Path consult intraop 1 bloc",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "88331",
      "description": "Path consult intraop 1 bloc",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "591723249"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 161.35,
              "providers": [
                {
                  "billed_charge": 220,
                  "npi": [
                    1790732360
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "22"
          ]
        }
      ]
    },
    {
      "name": "Intraop cyto path consult 2",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "88334",
      "description": "Intraop cyto path consult 2",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "591723249"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 97.84,
              "providers": [
                {
                  "billed_charge": 135,
                  "npi": [
                    1790732360
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "22"
          ]
        }
      ]
    },
    {
      "name": "Cardiovascular stress test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "93015",
      "description": "Cardiovascular stress test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "593140335"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 58.79,
              "providers": [
                {
                  "billed_charge": 181,
                  "npi": [
                    1043269871
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "99214",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "593140335"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 168.78,
              "providers": [
                {
                  "billed_charge": 338,
                  "npi": [
                    1043269871
                  ]
                }
              ]
            },
            {
              "allowed_amount": 197.74,
              "providers": [
                {
                  "billed_charge": 405,
                  "npi": [
                    1093493637
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Emergency dept visit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "99283",
      "description": "Emergency dept visit",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "590724459"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1535,
              "providers": [
                {
                  "billed_charge": 1535,
                  "npi": [
                    1306938071
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Tc99m sestamibi",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-09-26",
      "billing_code": "A9500",
      "description": "Tc99m sestamibi",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "593140335"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 118.75,
              "providers": [
                {
                  "billed_charge": 475,
                  "npi": [
                    1043269871
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    }
  ]
}