{
	"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": "19320101",
	"plan_market_type": "group",
	"last_updated_on": "2026-06-08",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "PR INTENSIVE OUTPATIENT PSYCHIA",
		"billing_code_type": "HCPCS",
		"billing_code_type_version": "2026",
		"billing_code": "S9480",
		"description": "Intensive Outpatient Psychia",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "393152758"
			},
			"service_code": ["02"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 156.55,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 4000.00,
					"npi": [1437035995]
				}]
			},{
				"allowed_amount": 438.01,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 4000.00,
					"npi": [1437035995]
				}]
			},{
				"allowed_amount": 438.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 4000.00,
					"npi": [1437035995]
				}]
			}]
		}]
	}]
}