{"reporting_entity_name": "Imagine360/HF", "reporting_entity_type": "HealthFirst Reporting", "last_updated_on": "2026-10-29", "version": "2.1.0", "out_of_network": [{"name": "Procedure Code 36415", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "36415", "description": "Procedure Code 36415", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 9.34, "providers": [{"billed_charge": 26.25, "npi": [1063497451]}, {"billed_charge": 38.22, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 80050", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "80050", "description": "Procedure Code 80050", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 36.84, "providers": [{"billed_charge": 317.18, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 80061", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "80061", "description": "Procedure Code 80061", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 13.39, "providers": [{"billed_charge": 177.9, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 81001", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "81001", "description": "Procedure Code 81001", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 3.17, "providers": [{"billed_charge": 57.16, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 82043", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "82043", "description": "Procedure Code 82043", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 5.78, "providers": [{"billed_charge": 87.82, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 82570", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "82570", "description": "Procedure Code 82570", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 5.18, "providers": [{"billed_charge": 68.91, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 82607", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "82607", "description": "Procedure Code 82607", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 15.08, "providers": [{"billed_charge": 144.58, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 82728", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "82728", "description": "Procedure Code 82728", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 13.63, "providers": [{"billed_charge": 135.12, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 82746", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "82746", "description": "Procedure Code 82746", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 14.7, "providers": [{"billed_charge": 141.88, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 83036", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "83036", "description": "Procedure Code 83036", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 9.71, "providers": [{"billed_charge": 89.2, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 83540", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "83540", "description": "Procedure Code 83540", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 6.47, "providers": [{"billed_charge": 45.72, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 83550", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "83550", "description": "Procedure Code 83550", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 8.74, "providers": [{"billed_charge": 61.76, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 84443", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "84443", "description": "Procedure Code 84443", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 16.8, "providers": [{"billed_charge": 156.74, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 85025", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "85025", "description": "Procedure Code 85025", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 7.77, "providers": [{"billed_charge": 54.65, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 86592", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "86592", "description": "Procedure Code 86592", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 4.27, "providers": [{"billed_charge": 45.93, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 86803", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "86803", "description": "Procedure Code 86803", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 14.27, "providers": [{"billed_charge": 174.3, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 87086", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "87086", "description": "Procedure Code 87086", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 8.07, "providers": [{"billed_charge": 72.98, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 87340", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "87340", "description": "Procedure Code 87340", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 10.33, "providers": [{"billed_charge": 101.34, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 87389", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "87389", "description": "Procedure Code 87389", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 24.08, "providers": [{"billed_charge": 129.93, "npi": [1952347791]}]}]}]}, {"name": "Procedure Code 88175", "billing_code_type": "CPT", "billing_code_type_version": "2.1.0", "billing_code": "88175", "description": "Procedure Code 88175", "allowed_amounts": [{"tin": {"type": "ein", "value": "061085178"}, "service_code": ["81"], "billing_class": "institutional", "payments": [{"allowed_amount": 26.61, "providers": [{"billed_charge": 131.73, "npi": [1952347791]}]}]}]}]}