{
  "reporting_entity_name" : "HealthPlanName",
  "reporting_entity_type" : "HealthPlanType",
  "last_updated_on" : "2024-04-01",
  "version" : "1.0.0",
  "out_of_network" : [ {
    "name" : "IMMUNIZATION ADMIN",
    "billing_code_type" : "CPT",
    "billing_code_type_version" : "2022",
    "billing_code" : "90471",
    "description" : "Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)",
    "allowed_amounts" : [ {
      "tin" : {
        "type" : "ein",
        "value" : "75-2123252"
      },
      "service_code" : [ "50" ],
      "billing_class" : "professional",
      "payments" : [ {
        "allowed_amount" : 19.54,
        "providers" : [ {
          "billed_charge" : 44.20,
          "npi" : [ 1659047975 ]
        }, {
          "billed_charge" : 44.00,
          "npi" : [ 1659047975 ]
        } ]
      } ]
    } ]
  } ]
}