{
	"reporting_entity_name": "SCRIPPS",
	"reporting_entity_type": "HEALTH PLAN",
	"issuer_name": "MC Scripps Health",
	"plan_name": "MC SCRIPPS HEALTH: SCRIPPS HEALTH PLAN",
	"plan_id_type": "HIOS",
	"plan_id": "330776371",
	"plan_market_type": "group",
	"last_updated_on": "2026-09-25",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "PR ELECTROCARDIOGRAM REPORT",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "93010",
		"description": "Electrocardiogram Report",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "201064117"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 15.89,
				"providers":[{
					"billed_charge": 58.00,
					"npi": [1538780127]
				}]
			},{
				"allowed_amount": 16.05,
				"providers":[{
					"billed_charge": 58.00,
					"npi": [1174865349]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462690851"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 15.89,
				"providers":[{
					"billed_charge": 60.00,
					"npi": [1316039977]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "871451688"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 15.89,
				"billing_code_modifier": ["59"],
				"providers":[{
					"billed_charge": 93.61,
					"npi": [1326486010]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "951691313"
			},
			"service_code": ["11", "21", "23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 14.39,
				"providers":[{
					"billed_charge": 29.00,
					"npi": [1114277787,1831423250]
				}]
			},{
				"allowed_amount": 28.79,
				"billing_code_modifier": ["76"],
				"providers":[{
					"billed_charge": 58.00,
					"npi": [1831423250]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 29.00,
					"npi": [1831423250]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "990326099"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 31.00,
					"npi": [1376596643]
				}]
			}]
		}]
	},{
		"name": "PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "97530",
		"description": "Therapeut Actvity Direct Pt Contact Each 15 Min",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "205067091"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GP", "59"],
				"providers":[{
					"billed_charge": 48.95,
					"npi": [1093564684]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "464813023"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 70.72,
				"providers":[{
					"billed_charge": 120.00,
					"npi": [1770926271]
				}]
			},{
				"allowed_amount": 106.08,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1770926271]
				}]
			},{
				"allowed_amount": 141.44,
				"providers":[{
					"billed_charge": 240.00,
					"npi": [1770926271]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "830523882"
			},
			"service_code": ["12"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 141.44,
				"billing_code_modifier": ["GO"],
				"providers":[{
					"billed_charge": 320.00,
					"npi": [1366206054,1407477250,1417258526]
				}]
			},{
				"allowed_amount": 141.44,
				"billing_code_modifier": ["GP"],
				"providers":[{
					"billed_charge": 320.00,
					"npi": [1013246693]
				}]
			}]
		}]
	}]
}