{
	"reporting_entity_name": "Hometown Health",
	"reporting_entity_type": "Group Health Plan",
	"issuer_name": "HTH Providers",
	"plan_name": "HOMETOWN HEALTH PROVIDERS: HTH PROVIDERS",
	"plan_id_type": "HIOS",
	"plan_id": "7730101",
	"plan_market_type": "group",
	"last_updated_on": "2026-04-08",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "PR ALCOHOL AND/OR DRUG SERVICES",
		"billing_code_type": "HCPCS",
		"billing_code_type_version": "2026",
		"billing_code": "H0015",
		"description": "Alcohol and/or Drug Services",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "812784418"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 2995.00,
					"npi": [1891430856]
				}]
			},{
				"allowed_amount": 539.10,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 2995.00,
					"npi": [1891430856]
				}]
			},{
				"allowed_amount": 539.10,
				"providers":[{
					"billed_charge": 2995.00,
					"npi": [1891430856]
				}]
			}]
		}]
	}]
}