{
  "reporting_entity_name" : "Baylor Scott & White Insurance Company",
  "reporting_entity_type" : "Health Insurer",
  "last_updated_on" : "2026-09-01",
  "version" : "2.0.0",
  "out_of_network" : [ {
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    "billing_code_type" : "CPT",
    "billing_code_type_version" : "2026",
    "billing_code" : "90999",
    "description" : "Unlisted dialysis procedure, inpatient or outpatient",
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      "payments" : [ {
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        "billing_code_modifier" : [ "V5" ],
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          "npi" : [ 1639582653 ]
        } ]
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        "billing_code_modifier" : [ "G5", "V5" ],
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          "npi" : [ 1639582653 ]
        } ]
      } ]
    } ]
  }, {
    "name" : "ALCOHL&/RX SRVC;INTENSV OP;CRISIS INTRVN&ACTV TX",
    "billing_code_type" : "HCPCS",
    "billing_code_type_version" : "2026",
    "billing_code" : "H0015",
    "description" : "Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education",
    "allowed_amounts" : [ {
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      "billing_class" : "institutional",
      "setting" : "outpatient",
      "payments" : [ {
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        "providers" : [ {
          "billed_charge" : 1400.00,
          "npi" : [ 1215574413 ]
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      } ]
    } ]
  } ]
}