{
  "reporting_entity_name" : "HealthPlanName",
  "reporting_entity_type" : "HealthPlanType",
  "last_updated_on" : "2024-08-29",
  "version" : "1.0.0",
  "out_of_network" : [ {
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    "billing_code_type" : "CPT",
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    "billing_code" : "99213",
    "description" : "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.",
    "allowed_amounts" : [ {
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        "type" : "ein",
        "value" : "87-3865998"
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      "service_code" : [ "20" ],
      "billing_class" : "professional",
      "payments" : [ {
        "allowed_amount" : 93.72,
        "providers" : [ {
          "billed_charge" : 250.00,
          "npi" : [ 1619346442 ]
        }, {
          "billed_charge" : 125.00,
          "npi" : [ 1619346442 ]
        } ]
      } ]
    } ]
  } ]
}