{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-04-23", "version": "1.0.0", "out_of_network": [{"name": "SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP", "billing_code_type": "CPT", "billing_code_type_version": "1.0.0", "billing_code": "99070", "description": "SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP", "allowed_amounts": [{"tin": {"type": "ein", "value": "27-1535521"}, "service_code": ["99"], "billing_class": "professional", "payments": [{"allowed_amount": 42.24, "providers": [{"billed_charge": 46.09, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 127.15, "providers": [{"billed_charge": 127.15, "npi": [0]}]}]}]}, {"name": "TOTAL CHARGE", "billing_code_type": "RC", "billing_code_type_version": "1.0.0", "billing_code": "0001", "description": "TOTAL CHARGE", "allowed_amounts": [{"tin": {"type": "ein", "value": "27-1535521"}, "service_code": ["99"], "billing_class": "institutional", "payments": [{"allowed_amount": 824.58, "providers": [{"billed_charge": 829.16, "npi": [0]}]}]}]}, {"name": "TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV", "billing_code_type": "CPT", "billing_code_type_version": "1.0.0", "billing_code": "92507", "description": "TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV", "allowed_amounts": [{"tin": {"type": "ein", "value": "27-0054898"}, "service_code": ["99"], "billing_class": "professional", "payments": [{"allowed_amount": 15.36, "providers": [{"billed_charge": 280, "npi": [0]}]}]}]}]}