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Payer price transparency data
Ambetter
Ambetter is a health insurer, part of the Centene Group family. They report 1.1K insurance plans covering 990K providers across 10K billing codes.
Source: public Transparency in Coverage filesRefreshed monthly, latest September 202618 monthly releases tracked
Monthly release
1.1K
Plans
990K
Providers (NPIs)
XX% vs prior month
110K
Tax IDs
XX% vs prior month
10K
Billing codes
XX% vs prior month
5M
Rate rows
XX% vs prior month
September 2026 release
What's in Ambetter's data
A profile of the machine-readable files Ambetter publishes, after PayerPrice parses and normalizes them.
Billing code types
Distinct codes and rate rows by code system
CodesRows
- RC2904.2M84%
- CPT6.9K690K14%
- HCPCS2.1K79K1.6%
- MS-DRG72020K0.4%
- CDT220<0.1%
Billing class
Professional vs. institutional rate rows
- Institutional4.2M84%
- Professional770K16%
Negotiation arrangement
How each rate is expressed
- Negotiated5M100%
- Percentage2.5K<0.1%
- Per Diem740<0.1%
- Fee Schedule470<0.1%
Plan identifiers
HIOS IDs mark individual and small-group plans; EINs mark employer plans
- HIOS ID1.1K100%
Providers by type
Distinct NPIs by entity type
- Individual (Type 1)940K96%
- Organization (Type 2)43K4.3%
Tax IDs by type
How provider groups are identified
- EIN110K100%
Top states
States with the most providers in network
- Florida94K
- Ohio89K
- Texas83K
- California73K
- Georgia51K
- Washington44K
Top specialties
Provider taxonomies with the most NPIs
- Family Nurse Practitioner81K
- Physician Assistant49K
- Family Medicine Physician49K
- Internal Medicine Physician42K
- Physical Therapist38K
- Certified Registered Nurse Anesthetist33K
These are the files. Want the rates inside them?
Look up Ambetter's negotiated rates by provider, TIN, billing code and plan.
Month-over-month history
Track how network size and rate volume change with each monthly release.
| Month | Plans | NPIs | Tax IDs | Billing codes | Rate rows |
|---|---|---|---|---|---|
| September 2026 | 1.1K | 990K | 110K | 10K | 5M |
| August 2026 | 1.1K | 900K | 100K | 8.9K | 760K |
| July 2026 | 1.1K | 1M | 110K | 9K | 810K |
| June 2026 | — | — | — | — | |
| May 2026 | — | — | — | — |
Data quality scorecard
6/6Good
This payer meets all 6 data quality criteria — their transparency files are comprehensive and well-structured.
Evaluated on the September 2026 release.
Professional & Institutional Rates
Data includes both professional and institutional billing class rates
Valid Tax IDs
More than 80% of Tax IDs are EIN or NPI (Organization) type
HIOS Plan
Data includes at least one HIOS-identified plan
Low Derived/Percentage Rates
Less than 10% of negotiation entries are derived or percentage type
Standard Code Coverage
Sufficient CPT and HCPCS code coverage with low proportion of LOCAL entries
Common Taxonomies
NPIs in the dataset cover at least 50 distinct provider taxonomies
How the score works
Each monthly release is checked against six criteria. 5–6 passing criteria rate Good, 3–4 rate Acceptable, and 0–2 rate Poor.
Behavioral, RX, and other specialty networks may not pass all criteria but can still contain complete and usable data.
Access the data
Ambetter's negotiated rates, in the tools your team already uses
PayerPrice turns raw transparency files into one clean, normalized dataset across 180+ payers, refreshed every month. Pick how you want to work with it.
API
REST API
Pull negotiated rates, providers and benchmarks into your own products and pipelines.
Explore the APISQL
Snowflake & Databricks
Query the full normalized dataset with SQL or PySpark, shared directly into your warehouse.
See data sharingAI
MCP server
Ask Claude, Cursor or your own agents questions like "What does Ambetter pay for CPT 99213 near me?"
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Frequently asked questions
About Ambetter's price transparency data.
What price transparency data does Ambetter publish?
Ambetter's September 2026 Transparency in Coverage files list 1.1K plans, 990K providers (NPIs), 110K tax IDs and 10K billing codes, for 5M negotiated rate rows in total.
Which states does Ambetter's network cover?
Ambetter's files include providers in 51 states. The states with the most in-network providers are Florida, Ohio, Texas, California, Georgia.
How often is Ambetter's data updated?
Payers must post updated machine-readable files every month. PayerPrice processes Ambetter's files monthly; the latest processed release is September 2026, and 18 monthly releases are available.
What is the Transparency in Coverage rule?
Since July 2022, the federal Transparency in Coverage rule has required most group health plans and health insurers to publish machine-readable files of their in-network negotiated rates and out-of-network allowed amounts, updated monthly. These files are the source for the data on this page.
How can I access Ambetter's negotiated rates?
Start a free PayerPrice trial to search Ambetter's rates in the web app, or book a demo to get the full dataset through the REST API, SQL in Snowflake or Databricks, or AI assistants through the PayerPrice MCP server.