{"reporting_entity_name": "First Choice Next, A Product of SHSC, Inc.","reporting_entity_type": "Exchange","last_updated_on": "2025-04-17","version": "1.0.0","out_of_network":[{"name":"Blood Count; Complete Cbc, Automated (Hgb, Hct, Rbc, Wbc, & Platelet) & Automated Differential Wbc","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"85025","description":"Blood Count; Complete Cbc, Automated (Hgb, Hct, Rbc, Wbc, & Platelet) & Automated Differential Wbc","allowed_amounts":[{"tin":{"type":"ein","value":"042944532"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":102.03,"providers":[{"billed_charge":340.09,"npi":[1740845445]}]}]}]},{"name":"Comprehensive Metabolic Panel","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"80053","description":"Comprehensive Metabolic Panel","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":14.04,"providers":[{"billed_charge":230.00,"npi":[1952704017]}]}]}]},{"name":"Invalid Procedure Code","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"0000000","description":"Invalid Procedure Code","allowed_amounts":[{"tin":{"type":"ein","value":"042944532"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":16.67,"providers":[{"billed_charge":55.55,"npi":[1740845445]}]}]}]},{"name":"Invalid Procedure Code","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"0000000","description":"Invalid Procedure Code","allowed_amounts":[{"tin":{"type":"ein","value":"571098556"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":130.00,"npi":[1033120837]},{"billed_charge":187.00,"npi":[1033120837]},{"billed_charge":218.00,"npi":[1033120837]},{"billed_charge":2436.00,"npi":[1033120837]},{"billed_charge":25.00,"npi":[1033120837]},{"billed_charge":3531.00,"npi":[1033120837]},{"billed_charge":38.00,"npi":[1033120837]},{"billed_charge":572.00,"npi":[1033120837]}]},{"allowed_amount":7733.00,"providers":[{"billed_charge":13652.00,"npi":[1033120837]}]}]}]},{"name":"Invalid Procedure Code","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"0000000","description":"Invalid Procedure Code","allowed_amounts":[{"tin":{"type":"ein","value":"582296052"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.60,"npi":[1154373843]},{"billed_charge":27.50,"npi":[1154373843]},{"billed_charge":29.50,"npi":[1154373843]},{"billed_charge":42.80,"npi":[1154373843]},{"billed_charge":98.50,"npi":[1154373843]}]},{"allowed_amount":109.22,"providers":[{"billed_charge":364.05,"npi":[1154373843]}]},{"allowed_amount":1399.20,"providers":[{"billed_charge":4664.00,"npi":[1154373843]}]},{"allowed_amount":1747.20,"providers":[{"billed_charge":5824.00,"npi":[1154373843]}]}]}]},{"name":"Invalid Procedure Code","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"0000000","description":"Invalid Procedure Code","allowed_amounts":[{"tin":{"type":"ein","value":"630974715"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":10.00,"npi":[1952374654]},{"billed_charge":241.00,"npi":[1952374654]},{"billed_charge":24530.00,"npi":[1952374654]},{"billed_charge":2677.78,"npi":[1952374654]},{"billed_charge":288.00,"npi":[1952374654]},{"billed_charge":5571.00,"npi":[1952374654]},{"billed_charge":5641.00,"npi":[1952374654]},{"billed_charge":6179.50,"npi":[1952374654]}]}]}]},{"name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99214","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","allowed_amounts":[{"tin":{"type":"ein","value":"582477208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":150.00,"providers":[{"billed_charge":150.00,"npi":[1023073764]}]}]}]},{"name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99214","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":138.05,"providers":[{"billed_charge":209.00,"npi":[1952704017]}]}]}]},{"name":"Radiologic examination, chest; single view","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7104526","description":"Radiologic examination, chest; single view","allowed_amounts":[{"tin":{"type":"ein","value":"570853635"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":11.73,"providers":[{"billed_charge":38.00,"npi":[1407243926]}]}]}]},{"name":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination a","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99232","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination a","allowed_amounts":[{"tin":{"type":"ein","value":"471345819"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":69.80,"providers":[{"billed_charge":149.00,"npi":[1295407195]}]}]}]},{"name":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination a","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99232","description":"Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination a","allowed_amounts":[{"tin":{"type":"ein","value":"570935917"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":91.91,"providers":[{"billed_charge":246.00,"npi":[1609211614]}]}]}]}]}
