{"reporting_entity_name":"Molina-Healthcare-of-Utah","reporting_entity_type":"health insurance issuer","last_updated_on":"2026-07-23","version":"2.0.0","provider_references":[{"provider_group_id":214045,"network_name":["IN NETWORK - PAR","INTERMOUNTAIN CONNECTCARE NETWORK","OUT OF NETWORK - NON PAR"],"provider_groups":[{"npi":[1013150218,1013297142,1013466978,1023397700,1033117874,1043689441,1063421451,1063428050,1073062659,1083649750,1083954275,1093014425,1093155988,1093326639,1114288891,1134141351,1144584228,1154796498,1164852745,1164951737,1174589105,1174779136,1174826697,1184322844,1194119149,1205072394,1205276086,1205874179,1205993607,1215238530,1215254529,1215323159,1215448246,1225775240,1235146937,1235349192,1245581487,1245743640,1255362323,1255617544,1255788303,1265804207,1265877096,1285860668,1285953166,1295256733,1295805364,1306097639,1306234828,1316646623,1326081084,1336362490,1336377472,1356376677,1366462913,1376651448,1376981274,1386051407,1386248136,1386719227,1386876530,1396858262,1396958369,1407322779,1407363633,1407435332,1427235811,1437207016,1457445744,1467753798,1477072015,1477703338,1497184303,1497752372,1497794960,1497916712,1518271097,1528460326,1598775074,1609019777,1609226091,1609818137,1619175189,1629206149,1639117823,1639490576,1649380049,1649502931,1659643385,1679938831,1689902603,1700244811,1700308772,1700321965,1710323860,1710937826,1720199201,1720264237,1720429491,1720464936,1720473390,1720595903,1720600067,1730318445,1740536374,1760596365,1770053167,1770580078,1790006237,1790188829,1801242391,1801452131,1821024480,1821307448,1831106681,1841844057,1851864433,1851952097,1861829665,1861899213,1891265914,1912229899,1912348731,1912411307,1922120468,1932507100,1932577749,1952332223,1952941734,1972058048,1972765402,1992109946,1992165054],"tin":{"type":"ein","value":"942854057","business_name":"CEDAR CITY INSTACARE"}}]}],"in_network":[{"negotiation_arrangement":"ffs","name":"OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN","negotiated_rates":[{"provider_references":[214045],"negotiated_prices":[{"setting":"both","negotiated_type":"FLATRATE","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]},{"setting":"outpatient","negotiated_type":"FLATRATE","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]}]}]},{"negotiation_arrangement":"ffs","name":"OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN","negotiated_rates":[{"provider_references":[214045],"negotiated_prices":[{"setting":"both","negotiated_type":"FLATRATE","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]},{"setting":"outpatient","negotiated_type":"FLATRATE","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]}]}]},{"negotiation_arrangement":"ffs","name":"OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN","negotiated_rates":[{"provider_references":[214045],"negotiated_prices":[{"setting":"both","negotiated_type":"FLATRATE","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]},{"setting":"outpatient","negotiated_type":"FLATRATE","negotiated_rate":69.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]}]}]},{"negotiation_arrangement":"ffs","name":"ONLINE DIGITAL E/M SVC EST PT  LT 7 D 11-20 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99422","description":"ONLINE DIGITAL E/M SVC EST PT  LT 7 D 11-20 MINUTES","negotiated_rates":[{"provider_references":[214045],"negotiated_prices":[{"setting":"both","negotiated_type":"FLATRATE","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]},{"setting":"outpatient","negotiated_type":"FLATRATE","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]}]}]},{"negotiation_arrangement":"ffs","name":"ONLINE DIGITAL E/M SVC EST PT  LT 7 D 21 Plus  MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99423","description":"ONLINE DIGITAL E/M SVC EST PT  LT 7 D 21 Plus  MINUTES","negotiated_rates":[{"provider_references":[214045],"negotiated_prices":[{"setting":"both","negotiated_type":"FLATRATE","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]},{"setting":"outpatient","negotiated_type":"FLATRATE","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]}]}]},{"negotiation_arrangement":"ffs","name":"ONLINE DIGITAL E/M SVC EST PT  LT 7 D 5-10 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99421","description":"ONLINE DIGITAL E/M SVC EST PT  LT 7 D 5-10 MINUTES","negotiated_rates":[{"provider_references":[214045],"negotiated_prices":[{"setting":"both","negotiated_type":"FLATRATE","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]},{"setting":"outpatient","negotiated_type":"FLATRATE","negotiated_rate":35.0,"expiration_date":"9999-12-31","billing_class":"Professional","service_code":["02","10"]}]}]}]}