{"reporting_entity_name":"BlueCross BlueShield of Tennessee","reporting_entity_type":"THIRD PARTY ADMINISTRATOR","last_updated_on":"2026-07-27","out_of_network":[{"name":"LAB/CHEMISTRY","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0301 80053","description":"LAB/CHEMISTRY","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":120.0,"providers":[{"billed_charge":120.0,"npi":[1558365890]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0258 J7030","description":"IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":23.75,"providers":[{"billed_charge":23.75,"npi":[1558365890]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0450 99284","description":"EMERG ROOM","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":1244.41,"providers":[{"billed_charge":2449.0,"npi":[1558365890]}]}]}]},{"name":"IV THERAPY","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0260 96374","description":"IV THERAPY","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":125.48,"providers":[{"billed_charge":222.0,"npi":[1558365890]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0450 99283","description":"EMERG ROOM","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":722.27,"providers":[{"billed_charge":1504.0,"npi":[1558365890]}]}]}]},{"name":"EKG/ECG","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0730 93005","description":"EKG/ECG","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":163.57,"providers":[{"billed_charge":377.0,"npi":[1558365890]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0450 99285","description":"EMERG ROOM","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":1898.62,"providers":[{"billed_charge":2864.0,"npi":[1558365890]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0301 84484","description":"LAB/CHEMISTRY","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":136.0,"providers":[{"billed_charge":136.0,"npi":[1558365890]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0305 85025","description":"LAB/HEMATOLOGY","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":51.28,"providers":[{"billed_charge":108.0,"npi":[1558365890]}]},{"allowed_amount":49.95,"providers":[{"billed_charge":108.0,"npi":[1558365890]}]}]}]},{"name":"LABORATORY","billing_code_type":"LOCAL","billing_code_type_version":"2026","billing_code":"0300 36415","description":"LABORATORY","allowed_amounts":[{"tin":{"type":"npi","value":"1558365890"},"service_code":["06","08","13","21","22","23","24","25","26","31","32","33","51","52","54","55","56","61","62"],"billing_class":"institutional","payments":[{"allowed_amount":8.91,"providers":[{"billed_charge":30.0,"npi":[1558365890]}]},{"allowed_amount":8.68,"providers":[{"billed_charge":30.0,"npi":[1558365890]}]}]}]}],"version":"2.0.0"}