{"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":840611484,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"840611484","business_name":"LABCORP DALLAS                     "},"npi":[1265418669,1881679751]}]},{"provider_group_id":752536818,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"752536818","business_name":"HEALTHTEXAS PROVIDER NTWK          "},"npi":[1467642611,1508211558,1114291192,1215542014]}]},{"provider_group_id":300491632,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"300491632","business_name":"TOPCARE MEDICAL GROUP INC          "},"npi":[1043604309]}]},{"provider_group_id":756004221,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"756004221","business_name":"DALLAS COUNTY HOSP DISTRICT        "},"npi":[1932123247]}]},{"provider_group_id":760652186,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"760652186","business_name":"ROSE IMAGING SPECIALISTS PA        "},"npi":[1114902525,1497936199,1467648824]}]},{"provider_group_id":752395756,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"752395756","business_name":"YOUR HEALTH CLINIC                 "},"npi":[1316708522]}]},{"provider_group_id":756002868,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"756002868","business_name":"UT SOUTHWESTERN MEDICAL SERVICE PLA"},"npi":[1326017872]}]},{"provider_group_id":611744250,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"611744250","business_name":"UNIFIED WOMENS HEALTHCARE OF TEXAS "},"npi":[1902852239,1912526328,1922097070]}]},{"provider_group_id":752617462,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"752617462","business_name":"TEXOMACARE                         "},"npi":[1962637967]}]},{"provider_group_id":364705614,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"364705614","business_name":"TEXOMACARE SPECIALTY PHYSICIANS    "},"npi":[1639195746]}]},{"provider_group_id":943478895,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"943478895","business_name":"NORTH DALLAS WOMENS CARE PA        "},"npi":[1033391073]}]},{"provider_group_id":823885476,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"823885476","business_name":"RENOVAR WELLCARE PLLC              "},"npi":[1366882623]}]},{"provider_group_id":842188069,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"842188069","business_name":"INSPIRE HEALTH PLLC                "},"npi":[1255626461]}]},{"provider_group_id":752544772,"network_name":["PCM                           "],"provider_groups":[{"tin":{"type":"ein","value":"752544772","business_name":"WILSON DO, JOHN W                  "},"npi":[1801854757]}]}],"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":12.24,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]}]},{"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":15.52,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"negotiation_arrangement":"ffs","name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84439","description":"assay of free thyroxine","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":11.25,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]}]},{"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":9.01,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":10.10,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"negotiation_arrangement":"ffs","name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85027","description":"complete cbc automated","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":8.41,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[300491632]}]},{"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":12.11,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82274","description":"assay test for blood fecal","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.70,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[756004221]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.70,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[756002868]}]},{"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":56.99,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[760652186]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":58.91,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[760652186]}]},{"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":167.42,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[760652186]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":174.59,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[760652186]}]},{"negotiation_arrangement":"ffs","name":"PAP SMEAR","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"88141","description":"cytopath c/v interpret","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":32.93,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]}]},{"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":[840611484]}]},{"negotiation_arrangement":"ffs","name":"PAP SMEAR","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"Q0091","description":"obtaining screen pap smear","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.09,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752395756]}]},{"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":3.00,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":3.75,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"negotiation_arrangement":"ffs","name":"PPACA COLORECTAL XRY/LAB","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82274","description":"assay test for blood fecal","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.70,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[756004221]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":20.70,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[756002868]}]},{"negotiation_arrangement":"ffs","name":"PPACA HEPATITIS C","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86803","description":"hepatitis c ab test","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.55,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"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":45.62,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[611744250]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":54.40,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90656","description":"iiv3 vacc no prsv 0.5 ml im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":19.54,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752617462]}]},{"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":20.53,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752617462]}]},{"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":6.10,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[611744250]}]},{"negotiation_arrangement":"ffs","name":"PPACA STD/HEPATITIS B","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86780","description":"treponema pallidum","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.21,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752395756]}]},{"negotiation_arrangement":"ffs","name":"PPACA STD/HEPATITIS B","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87389","description":"hiv-1 ag w/hiv-1&-2 ab ag ia","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":31.30,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[756002868]}]},{"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":56.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]}]},{"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":56.69,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":113.38,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[840611484]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99204","description":"office o/p new mod 45 min","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":173.20,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752395756]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":203.77,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[364705614]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99385","description":"prev visit new age 18-39","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":128.16,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[943478895]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99386","description":"prev visit new age 40-64","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":160.63,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[300491632]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":199.84,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[611744250]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99393","description":"prev visit est age 5-11","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":88.40,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99394","description":"prev visit est age 12-17","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.71,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]}]},{"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":121.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752536818]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":156.80,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[611744250]}]},{"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":126.89,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[823885476,842188069,943478895]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":131.05,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[752544772]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99459","description":"pelvic examination","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.14,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[611744250]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":28.70,"expiration_date":"9999-12-31","billing_class":"professional","setting":"outpatient","service_code":["11"]}],"provider_references":[611744250]}]}]}