{"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":2139206485,"network_name":[],"provider_groups":[{"npi":[1629688429,1821198755,1891852703],"tin":{"type":"ein","value":"232193572","business_name":"Geisinger - Bloomsburg Hospital"}}]}
], "in_network" : [
{"negotiation_arrangement":"ffs","name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2024","billing_code":"0250","description":"Pharmacy","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":1101.7,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"inpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2024","billing_code":"0250","description":"Pharmacy","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":845.1,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"inpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2024","billing_code":"0250","description":"Pharmacy","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":1101.7,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"inpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Injection_ nusinersen_ 0.1 mg","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"J2326","description":"Injection_ nusinersen_ 0.1 mg","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":135000.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Injection_ teprotumumab-trbw_ 10 mg","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"J3241","description":"Injection_ teprotumumab-trbw_ 10 mg","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":389.04,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Injection_ nusinersen_ 0.1 mg","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"J2326","description":"Injection_ nusinersen_ 0.1 mg","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":135000.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Robotic surgical system","billing_code_type":"HCPCS","billing_code_type_version":"2024","billing_code":"S2900","description":"Robotic surgical system","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"percentage","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"outpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Drugs requiring specific ident - drugs requiring detailed coding","billing_code_type":"RC","billing_code_type_version":"2024","billing_code":"0636","description":"Drugs requiring specific ident - drugs requiring detailed coding","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":1092.48,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"inpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Drugs requiring specific ident - drugs requiring detailed coding","billing_code_type":"RC","billing_code_type_version":"2024","billing_code":"0636","description":"Drugs requiring specific ident - drugs requiring detailed coding","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":917.35,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"inpatient"}],"provider_references":[2139206485]}]},
{"negotiation_arrangement":"ffs","name":"Drugs requiring specific ident - drugs requiring detailed coding","billing_code_type":"RC","billing_code_type_version":"2024","billing_code":"0636","description":"Drugs requiring specific ident - drugs requiring detailed coding","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":1025.0,"expiration_date":"9999-12-31","billing_class":"institutional","setting":"inpatient"}],"provider_references":[2139206485]}]}]}
