{
  "coveredBenefit": true,
  "authorizationRequired": false,
  "referralRequired": false,
  "estimatedPatientResponsibility": 30.0,
  "estimatedPlanPayment": 120.0,
  "costSharingDetails": {
    "copay": 30.0,
    "coinsurance": 0.0,
    "deductibleApplies": false
  }
}