{"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":"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":"570634747"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":89.10,"providers":[{"billed_charge":260.00,"npi":[1548279391]}]}]}]},{"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":41.48,"providers":[{"billed_charge":608.00,"npi":[1598253528]}]},{"allowed_amount":45.07,"providers":[{"billed_charge":608.00,"npi":[1447699970]}]}]}]},{"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":183.61,"providers":[{"billed_charge":1286.00,"npi":[1104408566,1780078907]}]}]}]},{"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":"821910968"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":75.77,"providers":[{"billed_charge":750.00,"npi":[1942867585]}]}]}]},{"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":124.44,"providers":[{"billed_charge":1280.00,"npi":[1508867698]}]},{"allowed_amount":129.35,"providers":[{"billed_charge":1280.00,"npi":[1245650019]}]}]}]},{"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":"570526943"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":22.17,"providers":[{"billed_charge":50.00,"npi":[1770306052]}]}]}]},{"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":"593259553"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":119.60,"providers":[{"billed_charge":346.00,"npi":[1619314283]}]}]}]},{"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":29.37,"providers":[{"billed_charge":87.00,"npi":[1235289851]}]}]}]},{"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":37.30,"providers":[{"billed_charge":108.00,"npi":[1235289851]}]}]}]}]}