{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-07-27", "version": "2.1.0", "out_of_network": [{"name": "APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "97035", "description": "APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "59-2808561"}, "service_code": ["11"], "billing_class": "professional", "billing_code_modifier": ["59"], "payments": [{"allowed_amount": 0, "providers": [{"billed_charge": 27.44, "npi": [0]}, {"billed_charge": 28, "npi": [0]}]}]}]}, {"name": "PSYCHOTHERAPY W/PATIENT 60 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "90837", "description": "PSYCHOTHERAPY W/PATIENT 60 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "83-4158176"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 122.53, "providers": [{"billed_charge": 133.67, "npi": [0]}]}]}]}]}