{"reporting_entity_name":"Key Benefit Administrators, Inc.","reporting_entity_type":"Third-Party Administrator","last_updated_on":"2025-09-01","version":"1.0.0","provider_references":[{"provider_group_id":"421707837","provider_groups":[{"tin":{"type":"ein","value":"421707837"},"npi":["1932166436"]}]},{"provider_group_id":"366006541","provider_groups":[{"tin":{"type":"ein","value":"366006541"},"npi":["1588612832","1174716633"]}]},{"provider_group_id":"223510467","provider_groups":[{"tin":{"type":"ein","value":"223510467"},"npi":["1750373908"]}]},{"provider_group_id":"208762724","provider_groups":[{"tin":{"type":"ein","value":"208762724"},"npi":["1366824104"]}]},{"provider_group_id":"204529593","provider_groups":[{"tin":{"type":"ein","value":"204529593"},"npi":["1417981986"]}]},{"provider_group_id":"263147146","provider_groups":[{"tin":{"type":"ein","value":"263147146"},"npi":["1003253881"]}]},{"provider_group_id":"880356466","provider_groups":[{"tin":{"type":"ein","value":"880356466"},"npi":["1558343772"]}]}],"in_network":[{"negotiation_arrangement":"ffs","name":"COVID IMMUNIZ/VACCINE","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"0124A","description":"Imm admn sarscov2 bivalent 30 mcg/0.3 ml bst","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":90.00,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["421707837"]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL LABS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"87389","description":"hiv-1 ag w/hiv-1&-2 ab ag ia","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":61.00,"expiration_date":"9999-12-31","billing_class":"institutional"}],"provider_references":["366006541"]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL MISCELLANEOUS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90471","description":"immunization admin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.87,"expiration_date":"9999-12-31","billing_class":"institutional"}],"provider_references":["366006541"]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.03,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.27,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["421707837"]}]},{"negotiation_arrangement":"ffs","name":"HOSPITAL MISCELLANEOUS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90658","description":"iiv3 vaccine splt 0.5 ml im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":15.00,"expiration_date":"9999-12-31","billing_class":"institutional"}],"provider_references":["366006541"]}]},{"negotiation_arrangement":"ffs","name":"PAP SMEAR","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"88175","description":"cytopath c/v auto fluid redo","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.59,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["223510467"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90673","description":"riv3 vaccine no preserv im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.00,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90686","description":"iiv4 vacc no prsv 0.5 ml im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.00,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["421707837"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90710","description":"mmrv vaccine sc","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":212.08,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["204529593"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90715","description":"tdap vaccine 7 yrs/> im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":34.90,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90746","description":"hepb vaccine 3 dose adult im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":64.96,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU ADULT & CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"91320","description":"sarscv2 vac 30mcg trs-suc im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":145.00,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]}]},{"negotiation_arrangement":"ffs","name":"PPACA IMMU CHILD","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90696","description":"dtap-ipv vaccine 4-6 yrs im","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":74.88,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["204529593"]}]},{"negotiation_arrangement":"ffs","name":"PPACA INJ ADMIN","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90460","description":"im admin 1st/only component","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":42.56,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["204529593"]}]},{"negotiation_arrangement":"ffs","name":"PPACA INJ ADMIN","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90461","description":"im admin each addl component","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":84.93,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["204529593"]}]},{"negotiation_arrangement":"ffs","name":"PPACA INJ ADMIN","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90471","description":"immunization admin","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":23.87,"expiration_date":"9999-12-31","billing_class":"institutional"}],"provider_references":["366006541"]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":17.03,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]},{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":21.27,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["421707837"]}]},{"negotiation_arrangement":"ffs","name":"PPACA INJ ADMIN","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90472","description":"immunization admin each add","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":13.12,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]}]},{"negotiation_arrangement":"ffs","name":"PPACA INJ ADMIN","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90480","description":"admn sarscov2 vacc 1 dose","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":18.11,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["208762724"]}]},{"negotiation_arrangement":"ffs","name":"PPACA MENTAL HEALTH","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"96127","description":"brief emotional/behav assmt","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":5.74,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["263147146"]}]},{"negotiation_arrangement":"ffs","name":"PPACA VISUAL ACUITY","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99174","description":"ocular instrumnt screen bil","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":7.23,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["204529593"]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99211","description":"off/op est may x req phy/qhp","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":12.31,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["880356466"]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99213","description":"office o/p est low 20 min","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":99.65,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["366006541"]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99392","description":"prev visit est age 1-4","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":102.95,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["204529593"]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99395","description":"prev visit est age 18-39","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":101.87,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["263147146"]}]},{"negotiation_arrangement":"ffs","name":"PREV PHYS OFFICE VISITS","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99459","description":"pelvic examination","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"negotiated","negotiated_rate":75.00,"expiration_date":"9999-12-31","billing_class":"professional"}],"provider_references":["263147146"]}]}]}