{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-07-27", "version": "2.1.0", "out_of_network": [{"name": "CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "98941", "description": "CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS", "allowed_amounts": [{"tin": {"type": "ein", "value": "47-5679288"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 5.95, "providers": [{"billed_charge": 55, "npi": [0]}]}]}]}, {"name": "ELEC STIM OTHER THAN WOUND", "billing_code_type": "HCPCS", "billing_code_type_version": "2.1.0", "billing_code": "G0283", "description": "ELEC STIM OTHER THAN WOUND", "allowed_amounts": [{"tin": {"type": "ein", "value": "47-5679288"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 0.29, "providers": [{"billed_charge": 30, "npi": [0]}]}]}]}, {"name": "MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "97140", "description": "MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "03-0506747"}, "service_code": ["11"], "billing_class": "professional", "billing_code_modifier": ["GP"], "payments": [{"allowed_amount": 22.12, "providers": [{"billed_charge": 118.18, "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": 22, "providers": [{"billed_charge": 22.68, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 234.35, "providers": [{"billed_charge": 234.35, "npi": [0]}]}]}]}, {"name": "THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "97112", "description": "THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA", "allowed_amounts": [{"tin": {"type": "ein", "value": "03-0506747"}, "service_code": ["11"], "billing_class": "professional", "billing_code_modifier": ["GP"], "payments": [{"allowed_amount": 25.97, "providers": [{"billed_charge": 175.94, "npi": [0]}]}]}]}, {"name": "THER PX 1/> AREAS EACH 15 MINUTES MASSAGE", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "97124", "description": "THER PX 1/> AREAS EACH 15 MINUTES MASSAGE", "allowed_amounts": [{"tin": {"type": "ein", "value": "47-5679288"}, "service_code": ["11"], "billing_class": "professional", "billing_code_modifier": ["59"], "payments": [{"allowed_amount": 0.85, "providers": [{"billed_charge": 40, "npi": [0]}]}]}]}, {"name": "THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "97530", "description": "THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "03-0506747"}, "service_code": ["11"], "billing_class": "professional", "billing_code_modifier": ["GP"], "payments": [{"allowed_amount": 39.38, "providers": [{"billed_charge": 133.31, "npi": [0]}]}]}]}, {"name": "THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "97110", "description": "THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES", "allowed_amounts": [{"tin": {"type": "ein", "value": "03-0506747"}, "service_code": ["11"], "billing_class": "professional", "billing_code_modifier": ["GP"], "payments": [{"allowed_amount": 32.59, "providers": [{"billed_charge": 264.97, "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": 946.45, "providers": [{"billed_charge": 1034.21, "npi": [0]}]}]}]}]}