{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-06-26", "version": "1.0.0", "out_of_network": [{"name": "OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "1.0.0", "billing_code": "99214", "description": "OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "99-2145793"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 109.92, "providers": [{"billed_charge": 183, "npi": [0]}]}]}]}, {"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": "06-1621470"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 3.67, "providers": [{"billed_charge": 3.67, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 145.83, "providers": [{"billed_charge": 145.83, "npi": [0]}]}]}]}, {"name": "THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG", "billing_code_type": "CPT", "billing_code_type_version": "1.0.0", "billing_code": "90868", "description": "THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG", "allowed_amounts": [{"tin": {"type": "ein", "value": "88-1219877"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 249.14, "providers": [{"billed_charge": 1270, "npi": [0]}]}]}]}]}