{
	"reporting_entity_name": "Hometown Health",
	"reporting_entity_type": "Group Health Plan",
	"issuer_name": "HTH Plan",
	"plan_name": "HOMETOWN HEALTH PLAN: HTH PLAN",
	"plan_id_type": "HIOS",
	"plan_id": "450106",
	"plan_market_type": "group",
	"last_updated_on": "2026-05-08",
	"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": "H0017",
		"description": "Alcohol and/or Drug Services",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "208838214"
			},
			"service_code": ["56"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 655.92,
				"providers":[{
					"billed_charge": 3644.00,
					"npi": [1780105551]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 3470.00,
					"npi": [1780105551]
				}]
			},{
				"allowed_amount": 624.60,
				"providers":[{
					"billed_charge": 3470.00,
					"npi": [1780105551]
				}]
			}]
		}]
	}]
}