{"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 Basic Life Support\/Emergency","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0429RH","description":"Ambulance Service Basic Life Support\/Emergency","allowed_amounts":[{"tin":{"type":"ein","value":"232128471"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":650.00,"providers":[{"billed_charge":650.00,"npi":[1518910827]}]}]}]},{"name":"Ambulance Service,Advanced Life Support\/Emergency Level 1","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0427RH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"232128471"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":925.00,"providers":[{"billed_charge":925.00,"npi":[1518910827]}]}]}]},{"name":"Ground Mileage, Per Statute Mile","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"A0425RH","description":"Ground Mileage, Per Statute Mile","allowed_amounts":[{"tin":{"type":"ein","value":"232128471"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":576.00,"providers":[{"billed_charge":576.00,"npi":[1518910827]}]},{"allowed_amount":612.00,"providers":[{"billed_charge":612.00,"npi":[1518910827]}]}]}]}]}