{"last_updated_on":"2026-06-26","out_of_network":[{"allowed_amounts":[{"billing_class":"professional","payments":[{"allowed_amount":117.72,"billing_code_modifier":["GP"],"providers":[{"billed_charge":117.72,"npi":["1386422467"]}]},{"allowed_amount":176.58,"billing_code_modifier":["GP"],"providers":[{"billed_charge":176.58,"npi":["1386422467"]}]},{"allowed_amount":58.86,"billing_code_modifier":["GP"],"providers":[{"billed_charge":58.86,"npi":["1386422467"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"922354092"}}],"billing_code":"97110","billing_code_type":"CPT","billing_code_type_version":"2023","description":"THERAPEUTIC EXERCISES","name":"THERAPEUTIC EXERCISES"},{"allowed_amounts":[{"billing_class":"professional","payments":[{"allowed_amount":136.48,"billing_code_modifier":["GP"],"providers":[{"billed_charge":136.48,"npi":["1386422467"]}]},{"allowed_amount":272.96,"billing_code_modifier":["GP"],"providers":[{"billed_charge":272.96,"npi":["1386422467"]}]},{"allowed_amount":204.72,"billing_code_modifier":["GP"],"providers":[{"billed_charge":204.72,"npi":["1386422467"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"922354092"}}],"billing_code":"97112","billing_code_type":"CPT","billing_code_type_version":"2023","description":"NEUROMUSCULAR REEDUCATION","name":"NEUROMUSCULAR REEDUCATION"},{"allowed_amounts":[{"billing_class":"professional","payments":[{"allowed_amount":227.52,"billing_code_modifier":["GP"],"providers":[{"billed_charge":227.52,"npi":["1386422467"]}]},{"allowed_amount":75.84,"billing_code_modifier":["GP"],"providers":[{"billed_charge":75.84,"npi":["1386422467"]}]},{"allowed_amount":151.68,"billing_code_modifier":["GP"],"providers":[{"billed_charge":151.68,"npi":["1386422467"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"922354092"}}],"billing_code":"97530","billing_code_type":"CPT","billing_code_type_version":"2023","description":"THERAPEUTIC ACTIVITIES","name":"THERAPEUTIC ACTIVITIES"}],"reporting_entity_name":"UPMC Health Plan","reporting_entity_type":"Health Insurance Issuer","version":"2.0.0"}
