; participating providers (A) Nonparticipating provider The term nonparticipating provider means, with respect to an item or service and a health plan, a physician or other health care provider who does not have a contractual relationship with the plan for furnishing such item or service under the plan. (B) Participating provider The term participating provider means, with respect to an item or service and a health plan, a physician or other health care provider who has a contractual relationship with the plan for furnishing such item or service under the plan. (11) Out-of-network rate The term out-of-network rate means, with respect to an item or service furnished in a State during a year to a participant or beneficiary of a health plan receiving such item or service from a nonparticipating provider or facility— (A) subject to subparagraphs (C) and (D), in the case such State has in effect a State law that provides for a method for determining the total amount payable under such health plan regulated by such State with respect to such item or service furnished by such provider or facility, such amount determined in accordance with such law; (B) subject to subparagraphs (C) and (D), in the case such State does not have in effect such a law with respect to such item or service, plan, and provider or facility— (i) subject to clause (ii), if the provider or facility (as applicable) and such plan agree on an amount of payment (including if agreed on through open negotiations under subsection (j)(1)) with respect to such item or service, such agreed on amount; or (ii) if such provider or facility (as applicable) and such plan enter the mediated dispute process under subsection (j) and do not so agree before the date on which a selected independent entity (as defined in paragraph (3) of such subsection) makes a determination with respect to such item or service under such subsection, the amount of such determination