{"reporting_entity_name": "Connecticare_CCI_COM","reporting_entity_type": "Health Insurance Issuer","last_updated_on": "2026-10-30","version": "2.0","provider_references": [                                                                                                                                                           
{"provider_group_id":1291730926,"network_name":["CCI Individual Exchange Choice Network"],"provider_groups":[{"npi":[1760402945],"tin":{"type":"ein","value":"237212022","business_name":"No business name found"}},{"npi":[1992097216],"tin":{"type":"ein","value":"066102160","business_name":"No business name found"}},{"npi":[1720250624],"tin":{"type":"ein","value":"208879300","business_name":"No business name found"}},{"npi":[1447268149,1740740737],"tin":{"type":"ein","value":"042108376","business_name":"No business name found"}},{"npi":[1205960994,1699309492],"tin":{"type":"ein","value":"060853106","business_name":"No business name found"}}]}
], "in_network" : [
{"negotiation_arrangement":"ffs","name":"Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82962","description":"Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":3.46,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90694","description":"AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":73.29,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Removal impacted cerumen requiring instrumentation, unilateral","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69210","description":"Removal impacted cerumen requiring instrumentation, unilateral","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":67.76,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90686","description":"Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":21.18,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99215","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":127.81,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Culture, bacterial; quantitative colony count, urine","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87086","description":"Culture, bacterial; quantitative colony count, urine","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":11.92,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90707","description":"Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":105.43,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":38.73,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Tympanometry (impedance testing)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92567","description":"Tympanometry (impedance testing)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":26.24,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Initial treatment, first degree burn, when no more than local treatment is required","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"16000","description":"Initial treatment, first degree burn, when no more than local treatment is required","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":65.51,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99384","description":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":137.86,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90687","description":"Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":9.89,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Varicella virus vaccine (VAR), live, for subcutaneous use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90716","description":"Varicella virus vaccine (VAR), live, for subcutaneous use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":217.68,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99395","description":"PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":119.45,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10060","description":"Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":104.75,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99403","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":108.39,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90649","description":"Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":172.85,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90734","description":"Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":190.71,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99393","description":"PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":108.48,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90685","description":"Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":20.5,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99383","description":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":126.97,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Incision and removal of foreign body, subcutaneous tissues; simple","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"10120","description":"Incision and removal of foreign body, subcutaneous tissues; simple","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":129.59,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Screening test, pure tone, air only","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"92551","description":"Screening test, pure tone, air only","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":16.63,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90672","description":"Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":26.33,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81002","description":"URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":3.85,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Particle agglutination; screen, each antibody","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86403","description":"Particle agglutination; screen, each antibody","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":15.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99404","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":139.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Removal foreign body from external auditory canal; without general anesthesia","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"69200","description":"Removal foreign body from external auditory canal; without general anesthesia","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":169.39,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"DESTRUCTION PREMALIGNANT LESION 2-14 EA","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17003","description":"DESTRUCTION PREMALIGNANT LESION 2-14 EA","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":7.37,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99202","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":65.63,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90660","description":"Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":28.97,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99205","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":182.31,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90700","description":"Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":32.73,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Blood count; hemoglobin (Hgb)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85018","description":"Blood count; hemoglobin (Hgb)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":3.46,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"56501","description":"Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":185.22,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Urine pregnancy test, by visual color comparison methods","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81025","description":"Urine pregnancy test, by visual color comparison methods","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":9.62,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90744","description":"Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":32.38,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90472","description":"IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":15.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Vital capacity, total (separate procedure)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94150","description":"Vital capacity, total (separate procedure)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":35.07,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Collection of venous blood by venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Collection of venous blood by venipuncture","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":5.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90471","description":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":15.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"DEMO /EVAL PT USE INHALER","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94664","description":"DEMO /EVAL PT USE INHALER","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":23.26,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90688","description":"Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":19.78,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90460","description":"IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":15.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90682","description":"Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":69.54,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90732","description":"PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":126.45,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90633","description":"Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":43.36,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":63.17,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Removal of foreign body, external eye; conjunctival superficial","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"65205","description":"Removal of foreign body, external eye; conjunctival superficial","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":71.88,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90756","description":"Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":30.67,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90713","description":"Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":51.5,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90648","description":"Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":14.48,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"17000","description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":76.27,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90710","description":"Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":324.13,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90674","description":"Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":32.37,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90662","description":"Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":116.07,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90715","description":"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":53.75,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87210","description":"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":6.54,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"OFF/OP EST MAY X REQ PHY/QHP","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99211","description":"OFF/OP EST MAY X REQ PHY/QHP","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":19.86,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90473","description":"Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":15.0,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99382","description":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":127.98,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99204","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":144.82,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90658","description":"Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":21.11,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94640","description":"PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":21.15,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87220","description":"Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":6.54,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Removal foreign body, intranasal; office type procedure","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"30300","description":"Removal foreign body, intranasal; office type procedure","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":280.48,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Skin test; tuberculosis, intradermal","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"86580","description":"Skin test; tuberculosis, intradermal","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":7.56,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90696","description":"DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":69.89,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99401","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":45.56,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99203","description":"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":94.64,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":94.92,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Screening test of visual acuity, quantitative, bilateral","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99173","description":"Screening test of visual acuity, quantitative, bilateral","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":3.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"N-INVAS EAR/PLS OXIMETRY 1","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"94760","description":"N-INVAS EAR/PLS OXIMETRY 1","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":4.42,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99394","description":"PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":118.95,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90671","description":"Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":272.69,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99402","description":"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":77.46,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"54050","description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":167.51,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99385","description":"INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":137.86,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"97602","description":"RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":45.17,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]},
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99392","description":"PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":108.98,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1291730926]}]}]}
