{
  "reporting_entity_name": "Triple-S Salud",
  "reporting_entity_type": "Health insurance issuer",
  "plan_name": "62A0",
  "plan_id_type": "EIN",
  "plan_id": "66-0555677",
  "plan_sponsor_name": "Triple-S Salud",
  "plan_market_type": "group",
  "last_updated_on": "2026-10-04",
  "version": "2.0.0",
  "out_of_network": [
    {
      "name": "E&M-Emergency Department Serv",
      "description": "Emergency dept visit",
      "billing_code_type": "CPT",
      "billing_code_type_version": "2022",
      "billing_code": "99282",
      "allowed_amounts": [
        {
          "tin": {
            "type": "npi",
            "value": "1962247254"
          },
          "service_code": [
            "23"
          ],
          "billing_class": "professional",
          "payments": [
            {
              "allowed_amount": 23.0000,
              "providers": [
                {
                  "billed_charge": 26.0000,
                  "npi": [
                    1962247254
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}