{"reporting_entity_name":"Molina-Healthcare-of-Washington","reporting_entity_type":"health insurance issuer","last_updated_on":"2026-07-10","version":"2.0.0","provider_references":[{"provider_group_id":210125,"network_name":["WA Network"],"provider_groups":[{"npi":[1659985554],"tin":{"type":"ein","value":"844965262","business_name":"TRANS WEST AMBULANCE SERVICE LLC"}}]}],"in_network":[{"negotiation_arrangement":"ffs","name":"AMBULANCE SERVICE BLS NONEMERGENCY TRANSPORT","billing_code_type":"CPT","billing_code_type_version":null,"billing_code":"A0428","description":"AMBULANCE SERVICE BLS NONEMERGENCY TRANSPORT","negotiated_rates":[{"provider_references":[210125],"negotiated_prices":[{"setting":"both","negotiated_type":"fee schedule","negotiated_rate":228.37,"expiration_date":"9999-12-31","billing_class":"professional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"AMBULANCE SERVICE BLS NONEMERGENCY TRANSPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE BLS NONEMERGENCY TRANSPORT","negotiated_rates":[{"provider_references":[210125],"negotiated_prices":[{"setting":"both","negotiated_type":"fee schedule","negotiated_rate":228.37,"expiration_date":"9999-12-31","billing_class":"professional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"GROUND MILEAGE PER STATUTE MILE","billing_code_type":"CPT","billing_code_type_version":null,"billing_code":"A0425","description":"GROUND MILEAGE PER STATUTE MILE","negotiated_rates":[{"provider_references":[210125],"negotiated_prices":[{"setting":"both","negotiated_type":"fee schedule","negotiated_rate":7.55,"expiration_date":"9999-12-31","billing_class":"professional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"GROUND MILEAGE PER STATUTE MILE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE PER STATUTE MILE","negotiated_rates":[{"provider_references":[210125],"negotiated_prices":[{"setting":"both","negotiated_type":"fee schedule","negotiated_rate":7.55,"expiration_date":"9999-12-31","billing_class":"professional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"ROTARY WING AIR MILEAGE PER STATUTE MILE","billing_code_type":"CPT","billing_code_type_version":null,"billing_code":"A0436","description":"ROTARY WING AIR MILEAGE PER STATUTE MILE","negotiated_rates":[{"provider_references":[210125],"negotiated_prices":[{"setting":"both","negotiated_type":"fee schedule","negotiated_rate":24.6,"expiration_date":"9999-12-31","billing_class":"professional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"ROTARY WING AIR MILEAGE PER STATUTE MILE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"A0436","description":"ROTARY WING AIR MILEAGE PER STATUTE MILE","negotiated_rates":[{"provider_references":[210125],"negotiated_prices":[{"setting":"both","negotiated_type":"fee schedule","negotiated_rate":24.6,"expiration_date":"9999-12-31","billing_class":"professional","service_code":["11"]}]}]}]}