{"reporting_entity_name":"Key Benefit Administrators, Inc.","reporting_entity_type":"Third-Party Administrator","last_updated_on":"2026-04-01","version":"2.0.0","provider_references":[{"provider_group_id":470634907,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"470634907","business_name":"COLUMBUS FAMILY PRACTICES ASSOCIATE"},"npi":[1316009004,1215907357]}]},{"provider_group_id":470551694,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"470551694","business_name":"COLUMBUS MEDICAL CENTER, PC        "},"npi":[1104820489]}]},{"provider_group_id":476006197,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"476006197","business_name":"CITY OF GENDA DBA GENOA COMMUNITY H"},"npi":[1720505522,1326723818]}]},{"provider_group_id":911858433,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"911858433","business_name":"THE NEBRASKA MEDICAL CENTER        "},"npi":[1356307581]}]},{"provider_group_id":470542043,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"470542043","business_name":"COLUMBUS COMMUNITY HOSPITAL        "},"npi":[1760589295,1548229743,1164652897]}]},{"provider_group_id":133757370,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"133757370","business_name":"LABCORP OVERLAND PARK              "},"npi":[1285014282]}]},{"provider_group_id":470711341,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"470711341","business_name":"PRAIRIE CREEK FAMILY MEDICINE      "},"npi":[1750769360]}]},{"provider_group_id":20769966,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"020769966","business_name":"VAXCARE CORPORATION                "},"npi":[1316058217]}]},{"provider_group_id":621433252,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"621433252","business_name":"HEALTHTRACKRX INDIANA INC          "},"npi":[1689639544]}]},{"provider_group_id":861137357,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"861137357","business_name":"COLUMBUS WOMENS HEALTHCARE         "},"npi":[1265173017]}]},{"provider_group_id":202856175,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"202856175","business_name":"CCH PEDIATRIC CLINIC PC            "},"npi":[1205919438]}]}],"in_network":[{"negotiation_arrangement":"ffs","name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"comprehen metabolic panel","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.52,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"lipid panel","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470551694,470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.74,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[911858433]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.96,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","description":"complete cbc w/auto diff wbc","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.10,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.88,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"FASTING BLOOD GLUCOSE/PHY","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83036","description":"hemoglobin glycosylated a1c","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.40,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"routine venipuncture","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.88,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470551694,470711341]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"comprehen metabolic panel","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.73,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":110.52,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"lipid panel","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470551694,470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":16.74,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[911858433]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":48.96,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83036","description":"hemoglobin glycosylated a1c","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.40,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84443","description":"assay thyroid stim hormone","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.00,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[911858433]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","description":"complete cbc w/auto diff wbc","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.10,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":38.88,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL MAMMOGRAMS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","description":"breast tomosynthesis bi","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.06,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL MAMMOGRAMS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","description":"scr mammo bi incl cad","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.16,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]}]},{"negotiation_arrangement":"ffs","name":"MAMMOGRAMS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","description":"breast tomosynthesis bi","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":30.06,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.04,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":22.61,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]}]},{"negotiation_arrangement":"ffs","name":"MAMMOGRAMS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77067","description":"scr mammo bi incl cad","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":116.16,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":65.33,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":67.03,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470542043]}]},{"negotiation_arrangement":"ffs","name":"PAP SMEAR","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88175","description":"cytopath c/v auto fluid redo","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.51,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[133757370]}]},{"negotiation_arrangement":"ffs","name":"PPACA ALCH/SUBST ABUSE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99408","description":"audit/dast 15-30 min","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":26.83,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"PPACA BLOOD DRAW/VENIPUNC","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"routine venipuncture","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.88,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[476006197]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.19,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470634907]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470551694,470711341]}]},{"negotiation_arrangement":"ffs","name":"PPACA HPV","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87624","description":"hpv high-risk types","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.40,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[133757370]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90750","description":"hzv vacc recombinant im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":129.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[20769966]}]},{"negotiation_arrangement":"ffs","name":"PPACA INJ ADMIN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90471","description":"immunization admin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[20769966]}]},{"negotiation_arrangement":"ffs","name":"PPACA MENTAL HEALTH","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96127","description":"brief emotional/behav assmt","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.96,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470551694]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":6.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"PPACA STD/HEPATITIS B","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87491","description":"chlmyd trach dna amp probe","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[621433252]}]},{"negotiation_arrangement":"ffs","name":"PPACA STD/HEPATITIS B","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87591","description":"n.gonorrhoeae dna amp prob","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":45.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[621433252]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99395","description":"prev visit est age 18-39","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.29,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[861137357]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":112.95,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[202856175,470711341]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":114.15,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[476006197]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99396","description":"prev visit est age 40-64","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":122.36,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[470551694,470634907]}]}]}