{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-08-25", "version": "2.1.0", "out_of_network": [{"name": "SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "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": 60.13, "providers": [{"billed_charge": 60.41, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "47-4362158"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 570, "providers": [{"billed_charge": 609.66, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["99"], "billing_class": "professional", "payments": [{"allowed_amount": 385.07, "providers": [{"billed_charge": 385.07, "npi": [0]}]}]}]}]}