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Medica
Medica is a health insurer. They report 2.6K insurance plans covering 2.6M providers across 170K billing codes.
Source: public Transparency in Coverage filesRefreshed monthly, latest September 202617 monthly releases tracked
Monthly release
2.6K
Plans
XX% vs prior month
2.6M
Providers (NPIs)
XX% vs prior month
670K
Tax IDs
XX% vs prior month
170K
Billing codes
XX% vs prior month
3.3B
Rate rows
XX% vs prior month
September 2026 release
What's in Medica's data
A profile of the machine-readable files Medica publishes, after PayerPrice parses and normalizes them.
Billing code types
Distinct codes and rate rows by code system
CodesRows
- CPT19K2.2B69%
- HCPCS48K900M28%
- CDT1.7K71M2.2%
- ICD92K32M1.0%
- MS-DRG8002.3M<0.1%
- RC760730K<0.1%
- CSTM-ALL200370K<0.1%
- LOCAL12K150K<0.1%
Billing class
Professional vs. institutional rate rows
- Institutional1.9B58%
- Professional1.3B41%
- Both42M1.3%
Negotiation arrangement
How each rate is expressed
- Negotiated2.5B76%
- Derived590M18%
- Fee Schedule160M5.0%
- Per Diem31M0.9%
- Percentage10M0.3%
Plan identifiers
HIOS IDs mark individual and small-group plans; EINs mark employer plans
- HIOS ID1305.2%
- EIN2.4K95%
Providers by type
Distinct NPIs by entity type
- Individual (Type 1)2.2M87%
- Organization (Type 2)340K13%
Tax IDs by type
How provider groups are identified
- EIN530K79%
- NPI (Individual)140K21%
- NPI (Organization)110<0.1%
Top states
States with the most providers in network
- California220K
- Texas190K
- New York160K
- Florida160K
- Pennsylvania120K
- Illinois100K
Top specialties
Provider taxonomies with the most NPIs
- Family Nurse Practitioner150K
- Clinical Social Worker150K
- Family Medicine Physician120K
- Physician Assistant120K
- Internal Medicine Physician110K
- Mental Health Counselor91K
These are the files. Want the rates inside them?
Look up Medica'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 | 2.6K | 2.6M | 670K | 170K | 3.3B |
| August 2026 | 5K | 2.5M | 670K | 61K | 2.9B |
| July 2026 | 5.1K | 2.4M | 510K | 35K | 2.3B |
| June 2026 | — | — | — | — | |
| May 2026 | — | — | — | — |
Data quality scorecard
4/6Acceptable
This payer scores 4/6 on data quality (Acceptable). Areas that don't meet the threshold: valid tax ids and low derived/percentage rates.
Evaluated on the September 2026 release.
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
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
Medica'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.
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REST API
Pull negotiated rates, providers and benchmarks into your own products and pipelines.
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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 Medica pay for CPT 99213 near me?"
Read the MCP docsBrowse all payers
Search the payer directoryAetna Group4
Blue Cross Blue Shield (BCBS)47
- Elevance (Anthem)
- BCBS Alabama
- BCBS Arizona
- BCBS Arkansas
- BCBS Florida Blue
- BCBS Idaho
- BCBS Illinois
- BCBS Kansas
- BCBS Kansas City
- BCBS Louisiana
- BCBS Massachusetts
- BCBS Michigan
- BCBS Minnesota
- BCBS Mississippi
- BCBS Montana
- BCBS Nebraska
- BCBS NewMexico
- BCBS NorthDakota
- BCBS Oklahoma
- BCBS North Carolina
- BCBS South Carolina
- BCBS Tennessee
- BCBS Texas
- BCBS Wyoming
- Blue Shield California
- Capital Blue Cross
- Capital Health Plan
- Care First
- Excellus BCBS
- Hawaii Medical Service Association
- Highmark BCBS Delaware
- Highmark BCBS Pennsylvania
- Highmark BCBS Western New York
- Highmark BCBS West Virginia
- Highmark Blue Shield Northeastern New York
- Highmark Blue Shield Pennsylvania
- Highmark Independence National Alliance
- Horizon BCBS NewJersey
- Independence Blue Cross
- Premera
- Regence BCBS Idaho
- Regence BCBS Oregon
- Regence BCBS Utah
- Regence BCBS Washington
- Wellmark
- BCBS Vermont
- BCBS Rhode Island
Cigna Healthcare1
Dean Health Plan Group2
United Healthcare1
Other79
- Triple-S Salud
- Alliant Health Plans
- Ameri Health
- Avera Health Plans
- Baylor Scott & White Health Plan
- CareSource (incl Common Ground Health Coop)
- Community Care Oklahoma
- Culinary Health Fund
- EMI Health
- EmblemHealth
- Fallon Health
- First Choice Health
- Geisinger Health Plan
- Harvard Pilgrim Health Care (Point32Health)
- Health Alliance
- Health Alliance HAP
- Health First New York
- Health Link
- Health New England
- Health Partners
- Health Smart
- Hometown Health
- Independent Health Association
- InterWest Health
- Johns Hopkins Health Plans
- Kaiser Permanente
- Lyra Health
- Luminare Health
- MVP Health Care
- MagnaCare
- Mass General Brigham (formerly AllWays Health Partners)
- Medica
- Medical Mutual
- Midlands Choice
- Moda Health
- Molina
- MultiPlan
- Neighborhood Health Plan of Rhode Island
- OSU Health Plan
- Sentara Health Plans (Optima Health)
- Oscar
- Pacific Source
- Physicians Health Plan
- Presbyterian Health Plan
- Priority Health
- Providence Health Plan
- Quartz
- Sanford Health Plan
- Select Health
- Texas Children's Health Plan
- The Alliance
- Trilogy Health Solutions
- Tufts Health Plan (Point32Health)
- UCare
- UHA Health Insurance
- UPMC Health Plan
- University of Utah Health Plans
- Ventura County Health Care Plan
- WellSense
- Western Health Advantage
- Yale Health
- CDPHP
- Community Health Choice
- Physicians Health Plan of Northern Indiana
- Inland Empire Health Plan
- Network Health
- Security Health Plan
- Wisconsin Physicians Group
- Group Health Cooperative of South Central Wisconsin
- Viva Health
- Magellan
- Aspirus Health Plan
- Group Health Cooperative of Eau Claire
- Sutter Health Plan
- Wellpoint
- Sharp Health Plan
- MedCost
- ComPsych
- Others
Frequently asked questions
About Medica's price transparency data.
What price transparency data does Medica publish?
Medica's September 2026 Transparency in Coverage files list 2.6K plans, 2.6M providers (NPIs), 670K tax IDs and 170K billing codes, for 3.3B negotiated rate rows in total.
Which states does Medica's network cover?
Medica's files include providers in 51 states. The states with the most in-network providers are California, Texas, New York, Florida, Pennsylvania.
How often is Medica's data updated?
Payers must post updated machine-readable files every month. PayerPrice processes Medica's files monthly; the latest processed release is September 2026, and 17 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 Medica's negotiated rates?
Start a free PayerPrice trial to search Medica'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.