{"reporting_entity_name":"Blue Cross Blue Shield of North Carolina","reporting_entity_type":"Health Insurance Issuer","plan_name":"Blue Home Bronze Standard 7500 with Novant Health","plan_id_type":"HIOS","plan_id":"11512NC0400023","plan_market_type":"Individual","last_updated_on":"2026-10-17","version":"2.0.0","out_of_network":[{"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":"56-1976679"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1285612374]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1225111560]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1184275570,1710911755,1962701698]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033849278,1073513388,1083119275,1083858047,1114476488,1144706011,1154681955,1306904255,1376692640,1417174616,1518452101,1568085066,1568410827,1598744823,1659796183,1679252746,1699037002,1871932202,1891180105,1912999111,1942298617,1942862198]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1972824902]}]}]},{"tin":[{"type":"ein","value":"56-2246180"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1558332833]}]}]},{"tin":[{"type":"ein","value":"56-1479712"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1255794574]}]}]}]},{"name":"Rvw Meds By RxDr In Rcrd","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"1159F","description":"Rvw Meds By RxDr In Rcrd","allowed_amounts":[{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1881891729,1972824902]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["02","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1144554395,1710515168,1710911755,1780636373,1801434402,1962701698]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["02","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1174529879,1225111560,1528313244,1790194504,1841782562]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1316923360]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033849278,1063815827,1073513388,1083119275,1083858047,1104980374,1114476488,1144706011,1154338713,1154681955,1306904255,1376692640,1417174616,1568085066,1568410827,1598195232,1598744823,1639588189,1679252746,1699037002,1770019812,1871932202,1891180105,1912999111,1942298617,1942862198,1972737930,1992770515]}]}]}]},{"name":"Lipid Panel Doc Rev","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"3008F","description":"Lipid Panel Doc Rev","allowed_amounts":[{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1316923360]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1174529879,1841782562]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1972824902]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033849278,1073513388,1083119275,1083858047,1104980374,1114476488,1144706011,1154338713,1154681955,1306904255,1376692640,1417174616,1518452101,1568410827,1598195232,1598744823,1659796183,1679252746,1699037002,1871715987,1891180105,1912999111,1942298617,1972618825,1972737930,1992770515]}]}]},{"tin":[{"type":"ein","value":"87-1366778"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1336397306]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1710911755,1780636373,1962701698]}]}]}]},{"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":"56-1667838"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033849278,1073513388,1083119275,1083858047,1114476488,1144706011,1154338713,1306904255,1376692640,1417174616,1518452101,1568085066,1568410827,1598744823,1659796183,1679252746,1871932202,1891180105,1912999111,1942862198]}]}]},{"tin":[{"type":"ein","value":"56-1976679"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1285612374]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1184275570,1710911755,1962701698]}]}]},{"tin":[{"type":"ein","value":"87-1366778"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1336397306]}]}]},{"tin":[{"type":"ein","value":"56-2246180"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1558332833]}]}]},{"tin":[{"type":"ein","value":"56-1479712"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1255794574]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1972824902]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1225111560]}]}]}]},{"name":"Rvw Meds By RxDr In Rcrd","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"1160F","description":"Rvw Meds By RxDr In Rcrd","allowed_amounts":[{"tin":[{"type":"ein","value":"87-1366778"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1336397306]}]}]},{"tin":[{"type":"ein","value":"85-0629801"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1043695869,1881891729,1972824902]}]}]},{"tin":[{"type":"ein","value":"56-1398929"}],"service_code":["02","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1144554395,1710515168,1710911755,1780636373,1801434402,1962701698]}]}]},{"tin":[{"type":"ein","value":"56-1667838"}],"service_code":["10","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033849278,1063815827,1073513388,1083119275,1083858047,1104980374,1114476488,1144706011,1154338713,1154681955,1306904255,1376692640,1417174616,1568085066,1568410827,1598195232,1598744823,1639588189,1679252746,1699037002,1770019812,1871932202,1891180105,1912999111,1942298617,1942862198,1972737930,1992770515]}]}]},{"tin":[{"type":"ein","value":"22-3849199"}],"service_code":["11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1316923360]}]}]},{"tin":[{"type":"ein","value":"56-0529945"}],"service_code":["02","11"],"billing_class":"Professional","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1174529879,1225111560,1528313244,1790194504,1841782562]}]}]}]}]}
