{
	"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": "5800320",
	"plan_market_type": "individual",
	"last_updated_on": "2026-06-08",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "PR ELECTRODES, PAIR",
		"billing_code_type": "HCPCS",
		"billing_code_type_version": "2026",
		"billing_code": "A4556",
		"description": "Electrodes, Pair",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "880307575"
			},
			"service_code": ["12"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 528.00,
					"npi": [1205976073]
				},{
					"billed_charge": 672.00,
					"npi": [1205976073]
				}]
			}]
		}]
	}]
}