{"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":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code":"90837","billing_code_type_version":"2026","description":"PSYTX W PT 60 MINUTES","allowed_amounts":[{"tin":{"type":"npi","value":"822391792"},"service_code":["10"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":205.00,"billing_code_modifier":["GT"],"providers":[{"billed_charge":205.00,"npi":[1598043226]}]}]},{"tin":{"type":"npi","value":"822391792"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":205.00,"billing_code_modifier":["  "],"providers":[{"billed_charge":205.00,"npi":[1598043226]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS\/QHP","billing_code_type":"CPT","billing_code":"97155","billing_code_type_version":"2026","description":"ADAPT BEHAVIOR TX PHYS\/QHP","allowed_amounts":[{"tin":{"type":"npi","value":"843594986"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":225.00,"billing_code_modifier":["  "],"providers":[{"billed_charge":225.00,"npi":[]}]}]}]}]}