{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-04-23", "version": "1.0.0", "out_of_network": [{"name": "HHCP-SVS OF AIDE,EA 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "1.0.0", "billing_code": "G0156", "description": "HHCP-SVS OF AIDE,EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "23-2311553"}, "service_code": ["12"], "billing_class": "professional", "billing_code_modifier": ["U7"], "payments": [{"allowed_amount": 0, "providers": [{"billed_charge": 146.13, "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": "27-1535521"}, "service_code": ["99"], "billing_class": "professional", "payments": [{"allowed_amount": 30.25, "providers": [{"billed_charge": 32.59, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 177.44, "providers": [{"billed_charge": 177.44, "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": 692.66, "providers": [{"billed_charge": 759.83, "npi": [0]}]}]}]}]}