{"reporting_entity_name": "Connecticare_CCI_ASO","reporting_entity_type": "Third Party","last_updated_on": "2026-10-30","version": "2.0","provider_references": [                                                                                                                                                                       
{"provider_group_id":1025727113,"network_name":["VIP Prime","HMO Prime Network"],"provider_groups":[{"npi":[1639206725],"tin":{"type":"ein","value":"223712962","business_name":"No business name found"}}]}
], "in_network" : [
{"negotiation_arrangement":"ffs","name":"Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90656","description":"Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"negotiation_arrangement":"ffs","name":"IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"90461","description":"IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"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":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"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":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"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":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"negotiation_arrangement":"ffs","name":"ADMN RSV MONOC ANTB IM NJX","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96381","description":"ADMN RSV MONOC ANTB IM NJX","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"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":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]},
{"negotiation_arrangement":"ffs","name":"ADMN RSV MONOC ANTB IM CNSL","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96380","description":"ADMN RSV MONOC ANTB IM CNSL","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"per diem","negotiated_rate":29.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional","setting":"outpatient"}],"provider_references":[1025727113]}]}]}