{"reporting_entity_name": "First Choice Next, A Product of SHSC, Inc.","reporting_entity_type": "Exchange","last_updated_on": "2025-05-09","version": "1.0.0","out_of_network":[{"name":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination and high level of medical decision","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99285","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination and high level of medical decision","allowed_amounts":[{"tin":{"type":"ein","value":"821910968"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":148.59,"providers":[{"billed_charge":1870.00,"npi":[1518433366]}]}]}]},{"name":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination and moderate level of medical deci","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99284","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination and moderate level of medical deci","allowed_amounts":[{"tin":{"type":"ein","value":"821910968"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":141.65,"providers":[{"billed_charge":1280.00,"npi":[1174836696]}]}]}]},{"name":"Manual Therapy Techniques, 1+ Regions, Each 15 Min","billing_code_type":"HCPCS","billing_code_type_version":"2025","billing_code":"97140GP","description":"Manual Therapy Techniques, 1+ Regions, Each 15 Min","allowed_amounts":[{"tin":{"type":"ein","value":"571056849"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.51,"providers":[{"billed_charge":67.98,"npi":[1982833240]}]},{"allowed_amount":63.03,"providers":[{"billed_charge":135.96,"npi":[1982833240]}]}]}]},{"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":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":126.64,"providers":[{"billed_charge":257.00,"npi":[1700490794]}]}]}]},{"name":"Therapeutic Actvities, Direct Patient Contact, Each 15 Min","billing_code_type":"HCPCS","billing_code_type_version":"2025","billing_code":"97530GP","description":"Therapeutic Actvities, Direct Patient Contact, Each 15 Min","allowed_amounts":[{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":128.97,"providers":[{"billed_charge":203.76,"npi":[1992727218]}]}]}]},{"name":"Therapeutic Actvities, Direct Patient Contact, Each 15 Min","billing_code_type":"HCPCS","billing_code_type_version":"2025","billing_code":"97530GP","description":"Therapeutic Actvities, Direct Patient Contact, Each 15 Min","allowed_amounts":[{"tin":{"type":"ein","value":"571056849"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":42.30,"providers":[{"billed_charge":55.00,"npi":[1982833240]}]}]}]}]}