Fallon Health
Last updated: March 2026
Fallon Health is a health insurer. They report 35 insurance plans covering 95K providers across 21K billing codes.
Data Version
Price Transparency Machine-Readable Files Snapshot
Overview
35
Plans
95K
Providers (NPIs)
XX% vs prev35K
Tax IDs
XX% vs prev21K
Billing Codes
140M
Data Rows
XX% vs prevGeographic Coverage
Top states by provider count:
Data Breakdown
Plans Type (HIOS vs EIN)
HIOS | 35 |
NPIs
Individual | 78K |
Group | 18K |
Tax IDs
EIN | 21K |
NPI (Individual) | 11K |
NPI (Group) | 3.4K |
Billing Code Type
| Codes | Rows | |
|---|---|---|
CPT | 12K | 120M |
HCPCS | 7.4K | 19M |
CDT | 870 | 1.9M |
RC | 550 | 71K |
MS-DRG | 780 | 860 |
Billing Class
| Rows | |
|---|---|
Institutional | 82M |
Professional | 58M |
Negotiated Type
| Rows | |
|---|---|
Negotiated | 120M |
Percentage | 17M |
Per Diem | 3.5K |
Fee Schedule | 1.6K |
Top States by # NPIs
Massachusetts | 31K |
California | 7.4K |
Texas | 5.2K |
New York | 4.8K |
Florida | 3.8K |
Top Taxonomies by # NPIs
Optometrist | 49K |
Ophthalmology Physician | 6.7K |
Internal Medicine Physician | 2.3K |
Physician Assistant | 2K |
Family Nurse Practitioner | 1.5K |
Want to explore Fallon Health's actual negotiated rates?
See code-level rates by provider, specialty, and geography.
Historical Metrics
| Month | Plans | NPIs | Tax IDs | Billing Codes | Data Rows |
|---|---|---|---|---|---|
March 2026 | 35 | 95K | 35K | 21K | 140M |
February 2026 | 35 | 95K | 35K | 21K | 140M |
January 2026 | — | — | — | — | |
December 2025 | — | — | — | — | |
November 2025 | — | — | — | — |
Show all 13 months
Data Coverage Scorecard
This payer scores 4/6 on data quality (Acceptable). Areas that don't meet the threshold: valid tax ids and low derived/percentage rates.
Professional & Institutional Rates
Data includes both professional and institutional billing class rates
Valid Tax IDs
Less 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
10% or more 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
Methodology
The scorecard evaluates each payer's monthly price transparency data against six quality criteria:
If 5–6 criteria pass, the overall rating is Good.
If 3–4 criteria pass, the rating is Acceptable.
If 0–2 criteria pass, the rating is Poor.
Behavioral, RX, and other specialty networks may not pass all criteria but can still contain complete and usable data.