{ "reporting_entity_name" : "HealthPlanName", "reporting_entity_type" : "HealthPlanType", "last_updated_on" : "2024-10-29", "version" : "1.0.0", "out_of_network" : [ { "name" : "BEHAVIORAL HEALTH; RES W/O ROOM&BOARD PER DIEM", "billing_code_type" : "HCPCS", "billing_code_type_version" : "2023", "billing_code" : "H0017", "description" : "Behavioral health; residential (hospital residential treatment program), without room and board, per diem", "allowed_amounts" : [ { "tin" : { "type" : "ein", "value" : "84-0802479" }, "billing_class" : "institutional", "payments" : [ { "allowed_amount" : 350.00, "providers" : [ { "billed_charge" : 3800.00, "npi" : [ 1821552480 ] } ] } ] } ] } ] }