{"reporting_entity_name":"Allegiance Benefit Plan Mgmt","reporting_entity_type":"third party","last_updated_on":"2026-09-30","version":"2.0.0","out_of_network":[{"name":"Allergen immunotherapy, 2+ inj","billing_code_type":"CPT","billing_code":"95117","billing_code_type_version":"2026","description":"Allergen immunotherapy, 2+ inj","allowed_amounts":[{"tin":{"type":"npi","value":"481209520"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":16.56,"billing_code_modifier":["  "],"providers":[{"billed_charge":30.00,"npi":[1255012126]},{"billed_charge":30.00,"npi":[1760575245]}]}]}]},{"name":"CMT, spinal, 3-4 regions","billing_code_type":"CPT","billing_code":"98941","billing_code_type_version":"2026","description":"CMT, spinal, 3-4 regions","allowed_amounts":[{"tin":{"type":"npi","value":"461073902"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":55.00,"billing_code_modifier":["  "],"providers":[{"billed_charge":55.00,"npi":[1598789927]}]}]}]}]}