{"reporting_entity_name":"Key Benefit Administrators, Inc.","reporting_entity_type":"Third-Party Administrator","last_updated_on":"2026-05-01","version":"2.0.0","out_of_network":[{"name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81002","description":"urinalysis nonauto w/o scope","allowed_amounts":[{"tin":{"type":"ein","value":"204768243","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":42.00,"providers":[{"billed_charge":42.00,"npi":[1437884731]}]}]}]},{"name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81003","description":"urinalysis auto w/o scope","allowed_amounts":[{"tin":{"type":"ein","value":"260845489","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.00,"providers":[{"billed_charge":20.00,"npi":[1407539893]}]}]}]},{"name":"PrEP","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81025","description":"urine pregnancy test","allowed_amounts":[{"tin":{"type":"ein","value":"260845489","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":41.00,"providers":[{"billed_charge":41.00,"npi":[1407539893]}]}]}]},{"name":"PPACA-PREG BACT/HEPA B","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87086","description":"urine culture/colony count","allowed_amounts":[{"tin":{"type":"ein","value":"382084239","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.50,"providers":[{"billed_charge":69.50,"npi":[1790721538]}]}]}]},{"name":"PPACA-PREG BACT/HEPA B","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87088","description":"urine bacteria culture","allowed_amounts":[{"tin":{"type":"ein","value":"382084239","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.32,"providers":[{"billed_charge":37.32,"npi":[1790721538]}]}]}]},{"name":"HI TECH IMAGING SERVICES","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"70551","description":"mri brain stem w/o dye","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":199.00,"providers":[{"billed_charge":199.00,"npi":[1477556868]}]}]}]},{"name":"XRAYS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"71045","description":"x-ray exam chest 1 view","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":25.00,"providers":[{"billed_charge":25.00,"npi":[1225327406]}]}]}]},{"name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"comprehen metabolic panel","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":10.00,"npi":[1316054315]}]}]}]},{"name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"lipid panel","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":10.00,"npi":[1316054315]}]}]}]},{"name":"CHRONIC DISEASE MANAGEMEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80069","description":"renal function panel","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":10.00,"npi":[1316054315]}]}]}]},{"name":"LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82962","description":"glucose blood test","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.68,"providers":[{"billed_charge":19.68,"npi":[1316054315]}]}]},{"tin":{"type":"ein","value":"742959210","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.20,"providers":[{"billed_charge":8.20,"npi":[1770843625]}]}]}]},{"name":"LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"83735","description":"assay of magnesium","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":10.00,"npi":[1316054315]}]}]}]},{"name":"LABS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84484","description":"assay of troponin quant","allowed_amounts":[{"tin":{"type":"ein","value":"741586031","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":10.00,"npi":[1316054315]}]}]}]},{"name":"PPACA HPV","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87624","description":"hpv high-risk types","allowed_amounts":[{"tin":{"type":"ein","value":"742959346","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":70.00,"providers":[{"billed_charge":70.00,"npi":[1538157086]}]}]}]},{"name":"CLEVER HEALTH BULK PAYMTS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"CSB","description":"CLEVER TELEHEALTH BULK PAYMENTS","allowed_amounts":[{"tin":{"type":"ein","value":"871412172","business_name":null},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.00,"providers":[{"billed_charge":29.00,"npi":[1972125805]}]},{"allowed_amount":58.00,"providers":[{"billed_charge":58.00,"npi":[1972125805]}]},{"allowed_amount":87.00,"providers":[{"billed_charge":87.00,"npi":[1972125805]}]},{"allowed_amount":100.00,"providers":[{"billed_charge":100.00,"npi":[1972125805]}]},{"allowed_amount":142.00,"providers":[{"billed_charge":142.00,"npi":[1972125805]}]},{"allowed_amount":145.00,"providers":[{"billed_charge":145.00,"npi":[1972125805]}]},{"allowed_amount":216.00,"providers":[{"billed_charge":216.00,"npi":[1972125805]}]}]}]}]}