{"reporting_entity_name": "First Choice Next, A Product of SHSC, Inc.","reporting_entity_type": "Exchange","last_updated_on": "2025-10-29","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":"590791028"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":528.00,"npi":[1639197395]}]}]}]},{"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":"811723202"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":126.00,"npi":[1063968196,1639656713]}]},{"allowed_amount":17.17,"providers":[{"billed_charge":126.00,"npi":[1427504554]}]}]}]},{"name":"Collection, Venous Blood, Venipuncture","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"36415","description":"Collection, Venous Blood, Venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"571118274"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":15.00,"npi":[1164455713]}]}]}]},{"name":"Collection, Venous Blood, Venipuncture","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"36415","description":"Collection, Venous Blood, Venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"590791028"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":26.00,"npi":[1639197395]}]}]}]},{"name":"Collection, Venous Blood, Venipuncture","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"36415","description":"Collection, Venous Blood, Venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":28.00,"npi":[1639656713]}]},{"allowed_amount":20.09,"providers":[{"billed_charge":28.00,"npi":[1427504554]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":11.00,"npi":[1568634525]},{"billed_charge":28.00,"npi":[1063968196]}]}]}]},{"name":"Collection, Venous Blood, Venipuncture","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"36415","description":"Collection, Venous Blood, Venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"881549656"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":10.00,"providers":[{"billed_charge":25.00,"npi":[1790949790]}]},{"allowed_amount":12.09,"providers":[{"billed_charge":25.00,"npi":[1790949790]}]}]}]},{"name":"Computed tomography, abdomen and pelvis; with contrast material(s)","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7417726","description":"Computed tomography, abdomen and pelvis; with contrast material(s)","allowed_amounts":[{"tin":{"type":"ein","value":"570853635"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":89.10,"providers":[{"billed_charge":590.00,"npi":[1407243926,1467502088]}]}]}]},{"name":"Computed tomography, abdomen and pelvis; with contrast material(s)","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7417726","description":"Computed tomography, abdomen and pelvis; with contrast material(s)","allowed_amounts":[{"tin":{"type":"ein","value":"570963518"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":87.30,"providers":[{"billed_charge":1671.00,"npi":[1982947214]}]}]}]},{"name":"Computed tomography, abdomen and pelvis; with contrast material(s)","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7417726","description":"Computed tomography, abdomen and pelvis; with contrast material(s)","allowed_amounts":[{"tin":{"type":"ein","value":"571004971"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":89.10,"providers":[{"billed_charge":271.00,"npi":[1700857638,1750642096,1821479593]}]}]}]},{"name":"Ct Scan, Head\/Brain; W\/O Contrast Matl","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7045026","description":"Ct Scan, Head\/Brain; W\/O Contrast Matl","allowed_amounts":[{"tin":{"type":"ein","value":"570853635"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":36.94,"providers":[{"billed_charge":190.00,"npi":[1346390952]}]},{"allowed_amount":41.48,"providers":[{"billed_charge":190.00,"npi":[1366592958,1467502088,1902006794]}]}]}]},{"name":"Ct Scan, Head\/Brain; W\/O Contrast Matl","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7045026","description":"Ct Scan, Head\/Brain; W\/O Contrast Matl","allowed_amounts":[{"tin":{"type":"ein","value":"570963518"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":45.07,"providers":[{"billed_charge":608.00,"npi":[1356785455]}]}]}]},{"name":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"93010","description":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","allowed_amounts":[{"tin":{"type":"ein","value":"571004971"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":9.82,"providers":[{"billed_charge":34.00,"npi":[1477846574]}]}]}]},{"name":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"93010","description":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","allowed_amounts":[{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8.29,"providers":[{"billed_charge":80.00,"npi":[1336265347]}]}]}]},{"name":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"93010","description":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","allowed_amounts":[{"tin":{"type":"ein","value":"821910968"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8.58,"providers":[{"billed_charge":56.00,"npi":[1467865378]}]}]}]},{"name":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"93010","description":"Electrocardiogram, Routine W\/At Least 12 Leads; Interpretation & Report Only","allowed_amounts":[{"tin":{"type":"ein","value":"831057917"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8.29,"providers":[{"billed_charge":30.36,"npi":[1154384410,1558711911]}]}]}]},{"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":"271369141"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":156.07,"providers":[{"billed_charge":1286.00,"npi":[1609546944,1851926133]}]},{"allowed_amount":183.61,"providers":[{"billed_charge":1286.00,"npi":[1427092832]}]}]}]},{"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":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":180.49,"providers":[{"billed_charge":1726.00,"npi":[1336265347]}]}]}]},{"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":187.61,"providers":[{"billed_charge":1870.00,"npi":[1619913324]}]}]}]},{"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":"831057917"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":153.42,"providers":[{"billed_charge":706.20,"npi":[1326605411,1376612390,1760940225]}]},{"allowed_amount":180.49,"providers":[{"billed_charge":706.20,"npi":[1043273261,1134758386,1184208142,1477516771,1558711911,1770681876,1801521729,1902148976,1962406769]}]},{"allowed_amount":232.67,"providers":[{"billed_charge":706.20,"npi":[1104408566,1124550934,1245761147]}]}]}]},{"name":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination and low level of medical decision","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99283","description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and\/or examination and low level of medical decision","allowed_amounts":[{"tin":{"type":"ein","value":"831057917"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":62.01,"providers":[{"billed_charge":288.72,"npi":[1730508896]}]},{"allowed_amount":72.95,"providers":[{"billed_charge":288.72,"npi":[1942262993]}]}]}]},{"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":"271369141"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":107.79,"providers":[{"billed_charge":874.00,"npi":[1841905783]}]}]}]},{"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":"471345819"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":124.44,"providers":[{"billed_charge":368.00,"npi":[1881272680]}]}]}]},{"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":"571004971"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":105.78,"providers":[{"billed_charge":368.00,"npi":[1417464843]}]},{"allowed_amount":124.44,"providers":[{"billed_charge":368.00,"npi":[1033732342,1164836557,1497045348,1508446956,1972947281,1982801593]}]}]}]},{"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":129.06,"providers":[{"billed_charge":1280.00,"npi":[1508094103]}]},{"allowed_amount":129.35,"providers":[{"billed_charge":1280.00,"npi":[1851887624]}]}]}]},{"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":"831057917"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":105.78,"providers":[{"billed_charge":485.28,"npi":[1114017225,1326605411,1730508896,1760940225]}]},{"allowed_amount":121.72,"providers":[{"billed_charge":485.28,"npi":[1093243412,1730612342,1922324169]}]},{"allowed_amount":124.44,"providers":[{"billed_charge":485.28,"npi":[1033370234,1124550934,1215657739,1245761147,1548222326,1740243351,1962406769]}]},{"allowed_amount":160.44,"providers":[{"billed_charge":485.28,"npi":[1801521729]}]}]}]},{"name":"Group Psychotherapy (Other Than, Multiple-Family Group)","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"90853","description":"Group Psychotherapy (Other Than, Multiple-Family Group)","allowed_amounts":[{"tin":{"type":"ein","value":"570542729"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":22.66,"providers":[{"billed_charge":60.00,"npi":[1336406529]}]}]}]},{"name":"Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99239","description":"Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter","allowed_amounts":[{"tin":{"type":"ein","value":"842571533"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":127.62,"providers":[{"billed_charge":459.52,"npi":[1073610861]}]}]},{"tin":{"type":"ein","value":"842571533"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":117.21,"providers":[{"billed_charge":459.52,"npi":[1679735047]}]}]}]},{"name":"Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"99239","description":"Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter","allowed_amounts":[{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":115.07,"providers":[{"billed_charge":682.00,"npi":[1437653847]}]},{"allowed_amount":139.13,"providers":[{"billed_charge":682.00,"npi":[1356364087]}]}]}]},{"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":"590791028"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1.00,"npi":[1639197395]},{"billed_charge":2.15,"npi":[1639197395]},{"billed_charge":5.10,"npi":[1639197395]},{"billed_charge":6.55,"npi":[1639197395]}]}]}]},{"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":"811723202"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":57.80,"npi":[1639656713]},{"billed_charge":6.10,"npi":[1639656713]}]},{"allowed_amount":0.20,"providers":[{"billed_charge":1.00,"npi":[1063968196]}]},{"allowed_amount":11.00,"providers":[{"billed_charge":55.00,"npi":[1063968196]}]},{"allowed_amount":16.20,"providers":[{"billed_charge":54.00,"npi":[1427504554]}]}]}]},{"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":111.49,"providers":[{"billed_charge":257.00,"npi":[1902440381]}]}]}]},{"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":"570679250"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":131.15,"providers":[{"billed_charge":266.00,"npi":[1467770131]}]}]}]},{"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":"571118274"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":131.15,"providers":[{"billed_charge":155.00,"npi":[1164455713]}]}]}]},{"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":"576000922"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":128.82,"providers":[{"billed_charge":265.00,"npi":[1649290362]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":118.16,"providers":[{"billed_charge":247.00,"npi":[1952315780]}]}]}]},{"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":"881549656"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":131.15,"providers":[{"billed_charge":200.00,"npi":[1790949790]}]}]}]},{"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":"931520079"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":111.49,"providers":[{"billed_charge":240.00,"npi":[1720636533]}]}]}]},{"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":"932839212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":111.49,"providers":[{"billed_charge":186.00,"npi":[1215637301]}]}]}]},{"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":"994277174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":111.49,"providers":[{"billed_charge":291.00,"npi":[1790438935]}]}]}]},{"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":["21","23"],"billing_class":"professional","payments":[{"allowed_amount":8.97,"providers":[{"billed_charge":38.00,"npi":[1407243926,1407384696,1467502088,1629316575]}]}]},{"tin":{"type":"ein","value":"570853635"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8.15,"providers":[{"billed_charge":38.00,"npi":[1346390952]}]},{"allowed_amount":11.59,"providers":[{"billed_charge":38.00,"npi":[1629456587]}]}]}]},{"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":"570963518"},"service_code":["21","23"],"billing_class":"professional","payments":[{"allowed_amount":9.75,"providers":[{"billed_charge":248.00,"npi":[1215912381,1447699970]}]}]}]},{"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":"571004971"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8.97,"providers":[{"billed_charge":30.00,"npi":[1790028868]}]}]}]},{"name":"Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7706326","description":"Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)","allowed_amounts":[{"tin":{"type":"ein","value":"570853635"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":26.70,"providers":[{"billed_charge":87.00,"npi":[1346390952]}]},{"allowed_amount":29.37,"providers":[{"billed_charge":87.00,"npi":[1235289851,1467502088]}]}]}]},{"name":"Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7706326","description":"Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)","allowed_amounts":[{"tin":{"type":"ein","value":"571004971"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":29.37,"providers":[{"billed_charge":98.00,"npi":[1720087745]}]}]}]},{"name":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7706726","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","allowed_amounts":[{"tin":{"type":"ein","value":"570853635"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":33.91,"providers":[{"billed_charge":108.00,"npi":[1346390952]}]},{"allowed_amount":37.30,"providers":[{"billed_charge":108.00,"npi":[1235289851,1467502088]}]}]}]},{"name":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","billing_code_type":"CPT","billing_code_type_version":"2025","billing_code":"7706726","description":"Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed","allowed_amounts":[{"tin":{"type":"ein","value":"571004971"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":37.30,"providers":[{"billed_charge":100.00,"npi":[1720087745]}]}]}]},{"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":"570359174"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":81.15,"providers":[{"billed_charge":189.00,"npi":[1952657348]}]}]}]},{"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":"99233","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":"582569828"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":125.92,"providers":[{"billed_charge":477.12,"npi":[1093344558]}]}]}]},{"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":"99233","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":"842571533"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":131.77,"providers":[{"billed_charge":477.12,"npi":[1073610861]}]}]}]},{"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":"99233","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":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":143.65,"providers":[{"billed_charge":647.00,"npi":[1356364087,1437653847]}]}]}]}]}