{"reporting_entity_name": "GHP_HMO","reporting_entity_type": "GHP_HMO","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":"A0427RH","description":"Ambulance Service,Advanced Life Support\/Emergency Level 1","allowed_amounts":[{"tin":{"type":"ein","value":"251595839"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1500.00,"providers":[{"billed_charge":1500.00,"npi":[1184601742]}]}]}]},{"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":"251595839"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":518.07,"providers":[{"billed_charge":1500.00,"npi":[1184601742]}]}]}]},{"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":"251595839"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":777.00,"providers":[{"billed_charge":777.00,"npi":[1184601742]}]}]}]},{"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":"251595839"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":281.82,"providers":[{"billed_charge":663.00,"npi":[1184601742]}]}]}]}]}