{"reporting_entity_name":"SENTARA HEALTH PLANS","reporting_entity_type":"HEALTH INSURANCE ISSUER","plan_name":"POS HSA HRSD","plan_id_type":"ein","plan_id":"546001749","plan_market_type":"group","plan_sponsor_name":"HRSD","issuer_name":"SENTARA HEALTH PLANS","last_updated_on":"2026-08-01","version":"2.0.0","out_of_network":[{"name":"Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"97112","description":"Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes","allowed_amounts":[{"tin":{"type":"ein","value":"273368837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.77,"providers":[{"billed_charge":100.00,"npi":[1871998278]}]},{"allowed_amount":43.55,"providers":[{"billed_charge":200.00,"npi":[1871998278]}]},{"allowed_amount":43.60,"providers":[{"billed_charge":200.00,"npi":[1871998278]}]},{"allowed_amount":62.42,"providers":[{"billed_charge":300.00,"npi":[1871998278]}]},{"allowed_amount":127.71,"providers":[{"billed_charge":300.00,"npi":[1871998278]}]}]},{"tin":{"type":"ein","value":"473075583"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.45,"providers":[{"billed_charge":95.00,"npi":[1659763050]}]},{"allowed_amount":28.30,"providers":[{"billed_charge":95.00,"npi":[1659763050]}]},{"allowed_amount":49.75,"providers":[{"billed_charge":190.00,"npi":[1659763050]}]},{"allowed_amount":53.20,"providers":[{"billed_charge":95.00,"npi":[1659763050]}]}]},{"tin":{"type":"ein","value":"541675677"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":183.49,"providers":[{"billed_charge":390.00,"npi":[1760467021]}]},{"allowed_amount":218.40,"providers":[{"billed_charge":390.00,"npi":[1760467021]}]},{"allowed_amount":291.20,"providers":[{"billed_charge":520.00,"npi":[1760467021]}]}]}]}]}