{"reporting_entity_name":"Allegiance Benefit Plan Mgmt","reporting_entity_type":"third party","last_updated_on":"2026-11-01","version":"2.0.0","out_of_network":[{"name":"CMT, spinal, 5 regions","billing_code_type":"CPT","billing_code":"98942","billing_code_type_version":"2026","description":"CMT, spinal, 5 regions","allowed_amounts":[{"tin":{"type":"npi","value":"861806913"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":36.00,"billing_code_modifier":["  "],"providers":[{"billed_charge":45.00,"npi":[1477807287]},{"billed_charge":45.00,"npi":[1861165284]}]},{"allowed_amount":36.00,"billing_code_modifier":["AT"],"providers":[{"billed_charge":45.00,"npi":[1477807287]},{"billed_charge":45.00,"npi":[1861165284]}]}]}]}]}