{
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  "reporting_entity_type" : "HealthPlanType",
  "last_updated_on" : "2025-01-28",
  "version" : "1.0.0",
  "out_of_network" : [ {
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    "billing_code_type_version" : "2023",
    "billing_code" : "H0018",
    "description" : "Behavioral health; short-term residential (nonhospital residential treatment program), without room and board, per diem",
    "allowed_amounts" : [ {
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        "type" : "ein",
        "value" : "93-3179942"
      },
      "billing_class" : "institutional",
      "payments" : [ {
        "allowed_amount" : 350.00,
        "providers" : [ {
          "billed_charge" : 3625.00,
          "npi" : [ 1710763917 ]
        } ]
      } ]
    } ]
  } ]
}