{"reporting_entity_name": "GQO_PPO","reporting_entity_type": "GQO_Risk Assuming Non Licensed Insurer","last_updated_on": "2026-10-07","version": "2.0","provider_references": [                                                                                                                                                         
{"provider_group_id":523362610,"network_name":[],"provider_groups":[{"npi":[1508911728],"tin":{"type":"ein","value":"161694674","business_name":"Minimally Invasive Surgical and Neuroscience Center LLC"}}]}
], "in_network" : [
{"negotiation_arrangement":"ffs","name":"Spinal disk surgery add-on","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"63035","description":"Spinal disk surgery add-on","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":1159.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[523362610]}]},
{"negotiation_arrangement":"ffs","name":"Remove spine lamina 1 lmbr","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"63047","description":"Remove spine lamina 1 lmbr","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":3708.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[523362610]}]},
{"negotiation_arrangement":"ffs","name":"Low back disk surgery","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"63030","description":"Low back disk surgery","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":3708.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[523362610]}]},
{"negotiation_arrangement":"ffs","name":"Remove spinal lamina add-on","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"63048","description":"Remove spinal lamina add-on","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":1159.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[523362610]}]},
{"negotiation_arrangement":"ffs","name":"Drain/inj joint/bursa w/o us","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"20610","description":"Drain/inj joint/bursa w/o us","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":37.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[523362610]}]}]}