{"reporting_entity_name": "Connecticare_CCI_COM","reporting_entity_type": "Health Insurance Issuer","last_updated_on": "2026-07-22","version": "1.0.0","provider_references": [                                                                                                                                                           
{"provider_group_id":2021763979,"provider_groups":[{"npi":[1083751549],"tin":{"type":"ein","value":"060646668"}},{"npi":[1861530214],"tin":{"type":"ein","value":"060646668"}},{"npi":[1720390487],"tin":{"type":"ein","value":"060646668"}},{"npi":[1861530214],"tin":{"type":"ein","value":"060646668"}},{"npi":[1083751549],"tin":{"type":"ein","value":"060646668"}},{"npi":[1720390487],"tin":{"type":"ein","value":"060646668"}},{"npi":[1083751549],"tin":{"type":"ein","value":"060646668"}},{"npi":[1861530214],"tin":{"type":"ein","value":"060646668"}},{"npi":[1083751549],"tin":{"type":"ein","value":"060646768"}},{"npi":[1659822369],"tin":{"type":"ein","value":"832682201"}},{"npi":[1720390487],"tin":{"type":"ein","value":"060646668"}},{"npi":[1083751549],"tin":{"type":"ein","value":"060646668"}},{"npi":[1861530214],"tin":{"type":"ein","value":"060646668"}},{"npi":[1083751549],"tin":{"type":"ein","value":"060646668"}},{"npi":[1861530214],"tin":{"type":"ein","value":"060646668"}},{"npi":[1154372159],"tin":{"type":"ein","value":"215740581"}},{"npi":[1083751549],"tin":{"type":"ein","value":"060646668"}}]}
],"in_network": [
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99396","description":"PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":113.06,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":102.37,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99244","description":"OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":142.16,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":101.55,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":92.63,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99397","description":"PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":125.15,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":128.2,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":16.35,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":66.79,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":93.56,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99391","description":"PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":84.3,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99381","description":"INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":81.61,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":67.7,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99243","description":"OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":104.54,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":124.61,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99386","description":"INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":145.03,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":89.94,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99387","description":"INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":157.58,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":87.6,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99245","description":"OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":187.72,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":124.61,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":114.94,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":49.93,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":44.53,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":30.27,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"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":102.47,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]},
{"negotiation_arrangement":"ffs","name":"OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99242","description":"OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN","negotiated_rates":[{"negotiated_prices":[{"negotiated_type":"fee schedule","negotiated_rate":71.21,"expiration_date":"9999-12-31","service_code":["11"],"billing_class":"professional"}],"provider_references":[2021763979]}]}]}
