{"reporting_entity_name": "Imagine360", "reporting_entity_type": "Third party administrator", "last_updated_on": "2026-10-29", "version": "2.1.0", "out_of_network": [{"name": "PSYCHOTHERAPY W/PATIENT 45 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "90834", "description": "PSYCHOTHERAPY W/PATIENT 45 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "47-1421985"}, "service_code": ["02"], "billing_class": "professional", "payments": [{"allowed_amount": 85, "providers": [{"billed_charge": 85, "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": 517.78, "providers": [{"billed_charge": 517.78, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "58-2422694"}, "service_code": ["11"], "billing_class": "professional", "payments": [{"allowed_amount": 1041.32, "providers": [{"billed_charge": 1041.32, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "59-1031071"}, "service_code": ["99"], "billing_class": "professional", "payments": [{"allowed_amount": 142.86, "providers": [{"billed_charge": 142.86, "npi": [0]}]}]}, {"tin": {"type": "ein", "value": "75-1617587"}, "service_code": ["11", "99"], "billing_class": "professional", "payments": [{"allowed_amount": 181.02, "providers": [{"billed_charge": 181.02, "npi": [0]}]}, {"allowed_amount": 486.4, "providers": [{"billed_charge": 486.4, "npi": [0]}]}]}]}]}