{"reporting_entity_name": "GQO_PPO","reporting_entity_type": "GQO_PPO","last_updated_on": "2026-10-07","version": "1.0.0","out_of_network":[{"name":"Ambulance Service,Advanced Life Support\/Emergency Level 1","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0427SH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"236003116"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":513.04,"providers":[{"billed_charge":920.00,"npi":[1174508006]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425SH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"236003116"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9.15,"providers":[{"billed_charge":17.78,"npi":[1174508006]}]}]}]},{"name":"Urgent care center global","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"S9083","description":"Urgent care center global","allowed_amounts":[{"tin":{"type":"ein","value":"593209688"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":211.00,"providers":[{"billed_charge":322.00,"npi":[1396830535]}]}]}]}]}