{
	"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": "9090102",
	"plan_market_type": "group",
	"last_updated_on": "2026-05-08",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "PR ALLERGEN SPEC IGE QUANT,EACH",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "86003",
		"description": "Allergen Spec Ige Quant,Each",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "311258010"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 44.33,
				"providers":[{
					"billed_charge": 271.44,
					"npi": [1619972254]
				}]
			},{
				"allowed_amount": 92.07,
				"providers":[{
					"billed_charge": 563.76,
					"npi": [1619972254]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 20.88,
					"npi": [1619972254]
				},{
					"billed_charge": 563.76,
					"npi": [1619972254]
				}]
			}]
		}]
	}]
}