{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-10-29", "version": "2.1.0", "out_of_network": [{"name": "HEMO OPD/HOME: HEMODIALYSIS COMP OR OTHER RATE", "billing_code_type": "RC", "billing_code_type_version": "2.1.0", "billing_code": "0821", "description": "HEMO OPD/HOME: HEMODIALYSIS COMP OR OTHER RATE", "allowed_amounts": [{"tin": {"type": "ein", "value": "23-1906900"}, "service_code": ["65"], "billing_class": "institutional", "payments": [{"allowed_amount": 452.48, "providers": [{"billed_charge": 9087.91, "npi": [0]}]}]}]}, {"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": 15.28, "providers": [{"billed_charge": 17.33, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 189.58, "providers": [{"billed_charge": 189.58, "npi": [0]}]}]}]}, {"name": "TOTAL CHARGE", "billing_code_type": "RC", "billing_code_type_version": "2.1.0", "billing_code": "0001", "description": "TOTAL CHARGE", "allowed_amounts": [{"tin": {"type": "ein", "value": "27-1535521"}, "service_code": ["99"], "billing_class": "institutional", "payments": [{"allowed_amount": 920.85, "providers": [{"billed_charge": 1935.28, "npi": [0]}]}]}]}]}