{
  "reporting_entity_name": "AMPS",
  "reporting_entity_type": "third party",
  "last_updated_on": "2026-06-26",
  "version": "v2.1.0",
  "out_of_network": [
    {
      "name": "MED: CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC",
      "billing_code_type": "MS-DRG",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "287",
      "description": "MED: CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 13177.85,
              "providers": [
                {
                  "billed_charge": 68701.1,
                  "npi": [
                    1184638942
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Destruct b9 lesion 1-14",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "17110",
      "description": "Destruct b9 lesion 1-14",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 143.42,
              "providers": [
                {
                  "billed_charge": 317,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Drain/inj joint/bursa w/us",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "20611",
      "description": "Drain/inj joint/bursa w/us",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263328413"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 128.25,
              "providers": [
                {
                  "billed_charge": 209,
                  "npi": [
                    1992941108
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Treat shoulder dislocation",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "23650",
      "description": "Treat shoulder dislocation",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537504"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 522.53,
              "providers": [
                {
                  "billed_charge": 1035,
                  "npi": [
                    1073688354
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Diagnostic laryngoscopy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "31575",
      "description": "Diagnostic laryngoscopy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263086555"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 165.62,
              "providers": [
                {
                  "billed_charge": 539,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Egd biopsy single/multiple",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "43239",
      "description": "Egd biopsy single/multiple",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 193.26,
              "providers": [
                {
                  "billed_charge": 2610,
                  "npi": [
                    1184638942
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct head/brain w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "70450",
      "description": "Ct head/brain w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310646568"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 49.42,
              "providers": [
                {
                  "billed_charge": 181,
                  "npi": [
                    1851390850
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "Ct maxillofacial w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "70486",
      "description": "Ct maxillofacial w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310646568"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 51.65,
              "providers": [
                {
                  "billed_charge": 199,
                  "npi": [
                    1851390850
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam chest 1 view",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "71045",
      "description": "X-ray exam chest 1 view",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310646568"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.1,
              "providers": [
                {
                  "billed_charge": 32,
                  "npi": [
                    1851390850
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "23"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam chest 2 views",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "71046",
      "description": "X-ray exam chest 2 views",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 45.71,
              "providers": [
                {
                  "billed_charge": 765,
                  "npi": [
                    1184638942
                  ]
                },
                {
                  "billed_charge": 266,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            },
            {
              "allowed_amount": 13.22,
              "providers": [
                {
                  "billed_charge": 38,
                  "npi": [
                    1851390850
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "X-ray exam ribs uni 2 views",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "71100",
      "description": "X-ray exam ribs uni 2 views",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 49.7,
              "providers": [
                {
                  "billed_charge": 640,
                  "npi": [
                    1184638942
                  ]
                }
              ]
            },
            {
              "allowed_amount": 13.64,
              "providers": [
                {
                  "billed_charge": 40,
                  "npi": [
                    1851390850
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct thorax w/dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "71260",
      "description": "Ct thorax w/dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350593390"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 233.9,
              "providers": [
                {
                  "billed_charge": 2305,
                  "npi": [
                    1053361642
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Mri neck spine w/o dye",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "72141",
      "description": "Mri neck spine w/o dye",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "411410766"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 241.42,
              "providers": [
                {
                  "billed_charge": 2394,
                  "npi": [
                    1396712725
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "X-ray exam of shoulder",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "73030",
      "description": "X-ray exam of shoulder",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 48.345,
              "providers": [
                {
                  "billed_charge": 457,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            },
            {
              "allowed_amount": 13.19,
              "providers": [
                {
                  "billed_charge": 35,
                  "npi": [
                    1851390850
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "X-ray exam of humerus",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "73060",
      "description": "X-ray exam of humerus",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 43.25,
              "providers": [
                {
                  "billed_charge": 427,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ct abd & pelv w/contrast",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "74177",
      "description": "Ct abd & pelv w/contrast",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350593390"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 421.13,
              "providers": [
                {
                  "billed_charge": 3037,
                  "npi": [
                    1053361642
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Dxa bone density axial",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "77080",
      "description": "Dxa bone density axial",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310874388"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 12.35,
              "providers": [
                {
                  "billed_charge": 61,
                  "npi": [
                    1346299153
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "22"
          ]
        }
      ]
    },
    {
      "name": "Metabolic panel total ca",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "80048",
      "description": "Metabolic panel total ca",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 12.69,
              "providers": [
                {
                  "billed_charge": 124,
                  "npi": [
                    1780633289
                  ]
                },
                {
                  "billed_charge": 135.6,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Comprehen metabolic panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "80053",
      "description": "Comprehen metabolic panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350593390"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 15.84,
              "providers": [
                {
                  "billed_charge": 81,
                  "npi": [
                    1053361642
                  ]
                }
              ]
            },
            {
              "allowed_amount": 10.56,
              "providers": [
                {
                  "billed_charge": 57,
                  "npi": [
                    1033154026
                  ]
                },
                {
                  "billed_charge": 20,
                  "npi": [
                    1760658371
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Lipid panel",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "80061",
      "description": "Lipid panel",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 20.09,
              "providers": [
                {
                  "billed_charge": 182.69,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            },
            {
              "allowed_amount": 13.39,
              "providers": [
                {
                  "billed_charge": 69,
                  "npi": [
                    1033154026
                  ]
                },
                {
                  "billed_charge": 24,
                  "npi": [
                    1760658371
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Urinalysis auto w/o scope",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "81003",
      "description": "Urinalysis auto w/o scope",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 3.38,
              "providers": [
                {
                  "billed_charge": 49,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of serum albumin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "82040",
      "description": "Assay of serum albumin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 7.43,
              "providers": [
                {
                  "billed_charge": 49,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Ur albumin quantitative",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "82043",
      "description": "Ur albumin quantitative",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311479038"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5.78,
              "providers": [
                {
                  "billed_charge": 25,
                  "npi": [
                    1033154026
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Vitamin d 25 hydroxy",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "82306",
      "description": "Vitamin d 25 hydroxy",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 44.4,
              "providers": [
                {
                  "billed_charge": 187,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of ck (cpk)",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "82550",
      "description": "Assay of ck (cpk)",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "421534506"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 6.51,
              "providers": [
                {
                  "billed_charge": 12,
                  "npi": [
                    1760658371
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of urine creatinine",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "82570",
      "description": "Assay of urine creatinine",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311479038"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5.18,
              "providers": [
                {
                  "billed_charge": 22,
                  "npi": [
                    1033154026
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay iga/igd/igg/igm each",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "82784",
      "description": "Assay iga/igd/igg/igm each",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 64,
              "providers": [
                {
                  "billed_charge": 64,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Glycosylated hemoglobin test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "83036",
      "description": "Glycosylated hemoglobin test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 14.57,
              "providers": [
                {
                  "billed_charge": 116,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            },
            {
              "allowed_amount": 9.71,
              "providers": [
                {
                  "billed_charge": 41,
                  "npi": [
                    1033154026
                  ]
                },
                {
                  "billed_charge": 18,
                  "npi": [
                    1760658371
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Immunoassay nonantibody",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "83516",
      "description": "Immunoassay nonantibody",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.53,
              "providers": [
                {
                  "billed_charge": 149,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Immunoassay quant nos nonab",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "83520",
      "description": "Immunoassay quant nos nonab",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 34.54,
              "providers": [
                {
                  "billed_charge": 172.7,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of magnesium",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "83735",
      "description": "Assay of magnesium",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 46,
              "providers": [
                {
                  "billed_charge": 46,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Organic acid single quant",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "83921",
      "description": "Organic acid single quant",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 146,
              "providers": [
                {
                  "billed_charge": 146,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of prealbumin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "84134",
      "description": "Assay of prealbumin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 21.89,
              "providers": [
                {
                  "billed_charge": 93,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay of vitamin b-1",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "84425",
      "description": "Assay of vitamin b-1",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 146,
              "providers": [
                {
                  "billed_charge": 146,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Assay thyroid stim hormone",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "84443",
      "description": "Assay thyroid stim hormone",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311479038"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 16.8,
              "providers": [
                {
                  "billed_charge": 71,
                  "npi": [
                    1033154026
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Assay of transferrin",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "84466",
      "description": "Assay of transferrin",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 19.14,
              "providers": [
                {
                  "billed_charge": 88,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Complete cbc w/auto diff wbc",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "85025",
      "description": "Complete cbc w/auto diff wbc",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350593390"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 11.66,
              "providers": [
                {
                  "billed_charge": 59,
                  "npi": [
                    1053361642
                  ]
                },
                {
                  "billed_charge": 137.11,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            },
            {
              "allowed_amount": 7.77,
              "providers": [
                {
                  "billed_charge": 14,
                  "npi": [
                    1760658371
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Complete cbc automated",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "85027",
      "description": "Complete cbc automated",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 9.71,
              "providers": [
                {
                  "billed_charge": 73,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            },
            {
              "allowed_amount": 6.47,
              "providers": [
                {
                  "billed_charge": 31,
                  "npi": [
                    1033154026
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Prothrombin time",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "85610",
      "description": "Prothrombin time",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 6.44,
              "providers": [
                {
                  "billed_charge": 67,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Thromboplastin time partial",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "85730",
      "description": "Thromboplastin time partial",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 9.02,
              "providers": [
                {
                  "billed_charge": 72,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Beta-2 glycoprotein antibody",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86146",
      "description": "Beta-2 glycoprotein antibody",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 25.45,
              "providers": [
                {
                  "billed_charge": 127.25,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Cardiolipin antibody ea ig",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86147",
      "description": "Cardiolipin antibody ea ig",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 25.45,
              "providers": [
                {
                  "billed_charge": 127.25,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Nuclear antigen antibody",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86235",
      "description": "Nuclear antigen antibody",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 125.51,
              "providers": [
                {
                  "billed_charge": 627.55,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Microsomal antibody each",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86376",
      "description": "Microsomal antibody each",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 14.55,
              "providers": [
                {
                  "billed_charge": 72.75,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Rheumatoid factor quant",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86431",
      "description": "Rheumatoid factor quant",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 5.67,
              "providers": [
                {
                  "billed_charge": 30,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Thyroglobulin antibody",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86800",
      "description": "Thyroglobulin antibody",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 15.91,
              "providers": [
                {
                  "billed_charge": 79.55,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Rbc antibody screen",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86850",
      "description": "Rbc antibody screen",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 14.66,
              "providers": [
                {
                  "billed_charge": 228,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Blood typing serologic abo",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86900",
      "description": "Blood typing serologic abo",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 4.49,
              "providers": [
                {
                  "billed_charge": 59,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Blood typing serologic rh(d)",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "86901",
      "description": "Blood typing serologic rh(d)",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 4.49,
              "providers": [
                {
                  "billed_charge": 37,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Flowcytometry/ tc 1 marker",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "88184",
      "description": "Flowcytometry/ tc 1 marker",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 89.55,
              "providers": [
                {
                  "billed_charge": 440.4,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Flowcytometry/tc add-on",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "88185",
      "description": "Flowcytometry/tc add-on",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 52.4,
              "providers": [
                {
                  "billed_charge": 282.9,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Flowcytometry/read 2-8",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "88187",
      "description": "Flowcytometry/read 2-8",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "200434866"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 36.33,
              "providers": [
                {
                  "billed_charge": 200,
                  "npi": [
                    1245494517
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "81"
          ]
        }
      ]
    },
    {
      "name": "Riv3 vaccine no preserv im",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "90673",
      "description": "Riv3 vaccine no preserv im",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 33,
              "providers": [
                {
                  "billed_charge": 33,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Psytx w pt 60 minutes",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "90837",
      "description": "Psytx w pt 60 minutes",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 217.28666666666666,
              "providers": [
                {
                  "billed_charge": 250,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Pure tone hearing test air",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "92551",
      "description": "Pure tone hearing test air",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 15.74,
              "providers": [
                {
                  "billed_charge": 38,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Electrocardiogram complete",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93000",
      "description": "Electrocardiogram complete",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263086555"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 20.1,
              "providers": [
                {
                  "billed_charge": 116,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Electrocardiogram tracing",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93005",
      "description": "Electrocardiogram tracing",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310538525"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 8.46,
              "providers": [
                {
                  "billed_charge": 184,
                  "npi": [
                    1780633289
                  ]
                }
              ]
            },
            {
              "allowed_amount": 342,
              "providers": [
                {
                  "billed_charge": 342,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Electrocardiogram report",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93010",
      "description": "Electrocardiogram report",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.41,
              "providers": [
                {
                  "billed_charge": 75,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "22"
          ]
        }
      ]
    },
    {
      "name": "Remote 30 day ecg rev/report",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93270",
      "description": "Remote 30 day ecg rev/report",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263086555"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 9.83,
              "providers": [
                {
                  "billed_charge": 189,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Ecg/review interpret only",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93272",
      "description": "Ecg/review interpret only",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263086555"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 31.08,
              "providers": [
                {
                  "billed_charge": 125,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Tte w/doppler complete",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93306",
      "description": "Tte w/doppler complete",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 179.07,
              "providers": [
                {
                  "billed_charge": 3453.1,
                  "npi": [
                    1063457380
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            },
            {
              "allowed_amount": 91.38,
              "providers": [
                {
                  "billed_charge": 295,
                  "npi": [
                    1265689111
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Doppler echo exam heart",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93321",
      "description": "Doppler echo exam heart",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 600,
              "providers": [
                {
                  "billed_charge": 600,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Doppler color flow add-on",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93325",
      "description": "Doppler color flow add-on",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1066,
              "providers": [
                {
                  "billed_charge": 1066,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Stress tte complete",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93351",
      "description": "Stress tte complete",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 3153,
              "providers": [
                {
                  "billed_charge": 3153,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "L hrt artery/ventricle angio",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "93458",
      "description": "L hrt artery/ventricle angio",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1003.94,
              "providers": [
                {
                  "billed_charge": 29775.19,
                  "npi": [
                    1063457380
                  ]
                }
              ],
              "billing_code_modifier": [
                "TC"
              ]
            },
            {
              "allowed_amount": 369.15,
              "providers": [
                {
                  "billed_charge": 797,
                  "npi": [
                    1265689111
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Breathing capacity test",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "94010",
      "description": "Breathing capacity test",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 10.19,
              "providers": [
                {
                  "billed_charge": 75,
                  "npi": [
                    1679525919
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Pulm funct tst plethysmograp",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "94726",
      "description": "Pulm funct tst plethysmograp",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 14.68,
              "providers": [
                {
                  "billed_charge": 114,
                  "npi": [
                    1679525919
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Co/membane diffuse capacity",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "94729",
      "description": "Co/membane diffuse capacity",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 11.4,
              "providers": [
                {
                  "billed_charge": 76,
                  "npi": [
                    1679525919
                  ]
                }
              ],
              "billing_code_modifier": [
                "26"
              ]
            }
          ],
          "service_code": [
            "21"
          ]
        }
      ]
    },
    {
      "name": "Brief emotional/behav assmt",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "96127",
      "description": "Brief emotional/behav assmt",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 8.365,
              "providers": [
                {
                  "billed_charge": 18,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Therapeutic exercises",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "97110",
      "description": "Therapeutic exercises",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 106.67,
              "providers": [
                {
                  "billed_charge": 318,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Pt eval low complex 20 min",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "97161",
      "description": "Pt eval low complex 20 min",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 284,
              "providers": [
                {
                  "billed_charge": 284,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Mod sed same phys/qhp 5/>yrs",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99152",
      "description": "Mod sed same phys/qhp 5/>yrs",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 15.59,
              "providers": [
                {
                  "billed_charge": 86.21,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Visual acuity screen",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99173",
      "description": "Visual acuity screen",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 3.74,
              "providers": [
                {
                  "billed_charge": 10,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit new",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99203",
      "description": "Office/outpatient visit new",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 140.63,
              "providers": [
                {
                  "billed_charge": 269,
                  "npi": [
                    1225192610
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit new",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99204",
      "description": "Office/outpatient visit new",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263086555"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 209.03,
              "providers": [
                {
                  "billed_charge": 471,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99211",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "340714585"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 150,
              "providers": [
                {
                  "billed_charge": 150,
                  "npi": [
                    1679525919
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99213",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "208762724"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 113.71,
              "providers": [
                {
                  "billed_charge": 115,
                  "npi": [
                    1982761896
                  ]
                },
                {
                  "billed_charge": 179,
                  "npi": [
                    1225192610
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99214",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350593390"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 121.43,
              "providers": [
                {
                  "billed_charge": 154,
                  "npi": [
                    1053361642
                  ]
                }
              ]
            },
            {
              "allowed_amount": 154.045,
              "providers": [
                {
                  "billed_charge": 362,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            },
            {
              "allowed_amount": 150.2,
              "providers": [
                {
                  "billed_charge": 270,
                  "npi": [
                    1225192610
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Office/outpatient visit est",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99215",
      "description": "Office/outpatient visit est",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263086555"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 227.6,
              "providers": [
                {
                  "billed_charge": 565,
                  "npi": [
                    1265689111
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Emergency dept visit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99283",
      "description": "Emergency dept visit",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537504"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 103.07,
              "providers": [
                {
                  "billed_charge": 1812,
                  "npi": [
                    1073688354
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Emergency dept visit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99284",
      "description": "Emergency dept visit",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 172.68,
              "providers": [
                {
                  "billed_charge": 986,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            },
            {
              "allowed_amount": 161.17,
              "providers": [
                {
                  "billed_charge": 724,
                  "npi": [
                    1225192610
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Prev visit est age 12-17",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99394",
      "description": "Prev visit est age 12-17",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 132.59,
              "providers": [
                {
                  "billed_charge": 197,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Prev visit est age 18-39",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "99395",
      "description": "Prev visit est age 18-39",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 145.55,
              "providers": [
                {
                  "billed_charge": 190,
                  "npi": [
                    1780467555
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "C1887 Catheter, guiding (may include infusion/perfusion capability)",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "C1887",
      "description": "C1887 Catheter, guiding (may include infusion/perfusion capability)",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 108,
              "providers": [
                {
                  "billed_charge": 108,
                  "npi": [
                    1063457380
                  ]
                },
                {
                  "billed_charge": 108,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "C1894  \tIntro/sheath, non-laser",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "C1894",
      "description": "C1894  \tIntro/sheath, non-laser",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 22.9,
              "providers": [
                {
                  "billed_charge": 22.9,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Colorectal scrn; hi risk ind",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "G0105",
      "description": "Colorectal scrn; hi risk ind",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 129.42,
              "providers": [
                {
                  "billed_charge": 1740,
                  "npi": [
                    1184638942
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Dexamethasone sodium phos",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "J1100",
      "description": "Dexamethasone sodium phos",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263328413"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 0.65,
              "providers": [
                {
                  "billed_charge": 48,
                  "npi": [
                    1992941108
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Inj heparin sodium per 1000u",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "J1644",
      "description": "Inj heparin sodium per 1000u",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1.08,
              "providers": [
                {
                  "billed_charge": 348.42,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Inj midazolam hydrochloride",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "J2250",
      "description": "Inj midazolam hydrochloride",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "350892672"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 0.105,
              "providers": [
                {
                  "billed_charge": 67.28,
                  "npi": [
                    1063457380
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Inj, propofol, 10 mg",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "J2704",
      "description": "Inj, propofol, 10 mg",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 1.96,
              "providers": [
                {
                  "billed_charge": 9.885,
                  "npi": [
                    1184638942
                  ]
                }
              ]
            },
            {
              "allowed_amount": 2.365,
              "providers": [
                {
                  "billed_charge": 11.115,
                  "npi": [
                    1073688354
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "Triamcinolone acet inj nos",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "J3301",
      "description": "Triamcinolone acet inj nos",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "263328413"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 4.64,
              "providers": [
                {
                  "billed_charge": 96,
                  "npi": [
                    1992941108
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    },
    {
      "name": "Ringers lactate infusion",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "J7120",
      "description": "Ringers lactate infusion",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310537095"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 3.57,
              "providers": [
                {
                  "billed_charge": 29.75,
                  "npi": [
                    1184638942
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "K0606  \rAutomatic external defibrillator, with integrated \relectrocardiogram analysis, garment type\tAed garment w elec analysis\t \r\rk060\r",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "K0606",
      "description": "K0606  \rAutomatic external defibrillator, with integrated \relectrocardiogram analysis, garment type\tAed garment w elec analysis\t \r\rk060\r",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "201121194"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 4845.02,
              "providers": [
                {
                  "billed_charge": 5059,
                  "npi": [
                    1164535274
                  ]
                }
              ]
            }
          ],
          "service_code": [
            "12"
          ]
        }
      ]
    },
    {
      "name": "L3670 - 274 SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED,\rINCLUDES FITTING AND ADJUSTMENT\r",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "L3670",
      "description": "L3670 - 274 SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED,\rINCLUDES FITTING AND ADJUSTMENT\r",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "310672132"
          },
          "billing_class": "institutional",
          "payments": [
            {
              "allowed_amount": 34,
              "providers": [
                {
                  "billed_charge": 34,
                  "npi": [
                    1457379448
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name": "L3980 UPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND\rADJUSTMENT\r",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2026-06-26",
      "billing_code": "L3980",
      "description": "L3980 UPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND\rADJUSTMENT\r",
      "allowed_amounts": [
        {
          "tin": {
            "type": "ein",
            "value": "311411364"
          },
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 432.69,
              "providers": [
                {
                  "billed_charge": 887,
                  "npi": [
                    1225192610
                  ]
                }
              ],
              "billing_code_modifier": [
                "RT"
              ]
            }
          ],
          "service_code": [
            "11"
          ]
        }
      ]
    }
  ]
}