{"reporting_entity_name":"Allegiance Benefit Plan Mgmt","reporting_entity_type":"third party","last_updated_on":"2026-07-28","version":"2.0.0","out_of_network":[{"name":"Comprehen Metabolic Panel","billing_code_type":"CPT","billing_code":"80053","billing_code_type_version":"2026","description":"Comprehen Metabolic Panel","allowed_amounts":[{"tin":{"type":"npi","value":"454772236"},"service_code":["21"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":15.84,"billing_code_modifier":["26"],"providers":[{"billed_charge":15.84,"npi":[1225103625]}]}]},{"tin":{"type":"npi","value":"454772236"},"service_code":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":15.84,"billing_code_modifier":["26"],"providers":[{"billed_charge":15.84,"npi":[1225103625]}]}]},{"tin":{"type":"npi","value":"454772236"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":15.84,"billing_code_modifier":["26"],"providers":[{"billed_charge":15.84,"npi":[1225103625]}]}]}]}]}