{"last_updated_on":"2026-07-23","out_of_network":[{"allowed_amounts":[{"billing_class":"professional","payments":[{"allowed_amount":10,"billing_code_modifier":[],"providers":[{"billed_charge":10,"npi":["1740646454"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"472980559"}}],"billing_code":"97010","billing_code_type":"CPT","billing_code_type_version":"2023","description":"HOT OR COLD PACKS THERAPY","name":"HOT OR COLD PACKS THERAPY"},{"allowed_amounts":[{"billing_class":"professional","payments":[{"allowed_amount":40,"billing_code_modifier":[],"providers":[{"billed_charge":40,"npi":["1740646454"]}]},{"allowed_amount":80,"billing_code_modifier":[],"providers":[{"billed_charge":80,"npi":["1740646454"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"472980559"}}],"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":40,"billing_code_modifier":[],"providers":[{"billed_charge":40,"npi":["1740646454"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"472980559"}}],"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":50,"billing_code_modifier":[],"providers":[{"billed_charge":50,"npi":["1740646454"]}]},{"allowed_amount":100,"billing_code_modifier":[],"providers":[{"billed_charge":100,"npi":["1740646454"]}]},{"allowed_amount":50,"billing_code_modifier":["59"],"providers":[{"billed_charge":50,"npi":["1740646454"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"472980559"}}],"billing_code":"97140","billing_code_type":"CPT","billing_code_type_version":"2023","description":"MANUAL THERAPY 1/> REGIONS","name":"MANUAL THERAPY 1/> REGIONS"},{"allowed_amounts":[{"billing_class":"professional","payments":[{"allowed_amount":35,"billing_code_modifier":[],"providers":[{"billed_charge":35,"npi":["1740646454"]}]}],"service_code":["11"],"tin":{"type":"ein","value":"472980559"}}],"billing_code":"G0283","billing_code_type":"HCPCS","billing_code_type_version":"2023","description":"E-STIM 1/>NOT WND CARE PART TX PLAN","name":"E-STIM 1/>NOT WND CARE PART TX PLAN"}],"reporting_entity_name":"UPMC Health Plan","reporting_entity_type":"Health Insurance Issuer","version":"2.0.0"}
