{"reporting_entity_name":"Blue Cross Blue Shield of North Carolina","reporting_entity_type":"Health Insurance Issuer","plan_name":"Blue Local Bronze 7000 with Atrium Health","plan_id_type":"HIOS","plan_id":"11512NC0410046","plan_market_type":"Individual","last_updated_on":"2026-08-17","version":"2.0.0","out_of_network":[{"name":"Pre-Prxd Rsk Et Al DOCD","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3017F","description":"Pre-Prxd Rsk Et Al DOCD","allowed_amounts":[{"tin":[{"type":"ein","value":"84-4067176"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1528773181]}]}]},{"tin":[{"type":"ein","value":"58-1728803"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1124090279,1245298249,1487621249,1538721923,1578511911,1619228632,1629045380,1710908546,1770985459,1811567662,1881995371,1952052466]}]}]},{"tin":[{"type":"ein","value":"56-0928089"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033178694,1053687954,1073574604,1194010835,1568968881,1609201748,1689178600,1750384343,1801026810,1851555858,1982839197]}]}]}]},{"name":"Docrev Cur Meds By Elig Clin","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"G8427","description":"Docrev Cur Meds By Elig Clin","allowed_amounts":[{"tin":[{"type":"ein","value":"58-1728803"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1124090279,1124472170,1194785196,1245298249,1487621249,1538721923,1578511911,1619228632,1629045380,1710908546,1770985459,1811567662,1851359749,1881995371,1922688258,1952052466]}]}]},{"tin":[{"type":"ein","value":"84-3930503"}],"service_code":["10"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1013122092]}]}]},{"tin":[{"type":"ein","value":"56-0928089"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033178694,1053687954,1073574604,1194010835,1306088380,1336773217,1568968881,1609201748,1689178600,1750384343,1801026810,1851555858,1922620517,1982839197]}]}]},{"tin":[{"type":"ein","value":"84-4067176"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1528773181]}]}]}]},{"name":"Diast Bp 80-89 Mm Hg","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3078F","description":"Diast Bp 80-89 Mm Hg","allowed_amounts":[{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1073735155]}]}]},{"tin":[{"type":"ein","value":"58-1728803"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1093716797,1124090279,1124472170,1194785196,1245298249,1578511911,1619228632,1629045380,1770985459,1952052466]}]}]},{"tin":[{"type":"ein","value":"56-2154524"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1356311153]}]}]},{"tin":[{"type":"ein","value":"56-0928089"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033178694,1336773217,1568968881,1710308523,1982839197]}]}]}]},{"name":"Syst Bp Ge 130 - 139Mm Hg","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3074F","description":"Syst Bp Ge 130 - 139Mm Hg","allowed_amounts":[{"tin":[{"type":"ein","value":"56-0928089"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1053687954,1194010835,1306088380,1336773217,1568968881,1750384343,1982839197]}]}]},{"tin":[{"type":"ein","value":"58-1728803"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1093716797,1124090279,1194785196,1245298249,1578511911,1629045380,1710908546,1770985459,1952052466]}]}]},{"tin":[{"type":"ein","value":"56-2154524"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1356311153]}]}]},{"tin":[{"type":"ein","value":"20-3555819"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1073735155]}]}]}]}]}
