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Presbyterian Health Plan
Presbyterian Health Plan is a health insurer. They report 1 insurance plans covering 22K providers across 3.6K billing codes.
Source: public Transparency in Coverage filesRefreshed monthly, latest August 202615 monthly releases tracked
Monthly release
1
Plans
22K
Providers (NPIs)
XX% vs prior month
2.4K
Tax IDs
XX% vs prior month
3.6K
Billing codes
XX% vs prior month
190K
Rate rows
XX% vs prior month
August 2026 release
What's in Presbyterian Health Plan's data
A profile of the machine-readable files Presbyterian Health Plan publishes, after PayerPrice parses and normalizes them.
Billing code types
Distinct codes and rate rows by code system
CodesRows
- CPT2.5K160K84%
- HCPCS99028K14%
- MS-DRG531.6K0.8%
- ADA291.1K0.6%
Billing class
Professional vs. institutional rate rows
- Institutional110K56%
- Professional85K44%
Negotiation arrangement
How each rate is expressed
- Negotiated140K71%
- Percentage57K29%
Plan identifiers
HIOS IDs mark individual and small-group plans; EINs mark employer plans
- EIN1100%
Providers by type
Distinct NPIs by entity type
- Individual (Type 1)20K87%
- Organization (Type 2)2.8K13%
Tax IDs by type
How provider groups are identified
- EIN2.4K100%
Top states
States with the most providers in network
- New Mexico10K
- Texas3.4K
- Colorado3K
- Arizona700
- California570
- Florida490
Top specialties
Provider taxonomies with the most NPIs
- Family Nurse Practitioner1.8K
- Family Medicine Physician1.6K
- Diagnostic Radiology Physician1.4K
- Internal Medicine Physician1K
- Physician Assistant1K
- Emergency Medicine Physician910
These are the files. Want the rates inside them?
Look up Presbyterian Health Plan'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 |
|---|---|---|---|---|---|
| August 2026 | 1 | 22K | 2.4K | 3.6K | 190K |
| July 2026 | 1 | 22K | 2.4K | 2.9K | 150K |
| June 2026 | 1 | 22K | 2.4K | 2.9K | 150K |
| May 2026 | — | — | — | — | |
| April 2026 | — | — | — | — |
Data quality scorecard
3/6Acceptable
This payer scores 3/6 on data quality (Acceptable). 3 criteria did not meet the threshold.
Evaluated on the August 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 does not include any HIOS-identified plans
Low Derived/Percentage Rates
10% or more of negotiation entries are derived or percentage type
Standard Code Coverage
Insufficient CPT / HCPCS code coverage, or too many 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
Presbyterian Health Plan'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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MCP server
Ask Claude, Cursor or your own agents questions like "What does Presbyterian Health Plan pay for CPT 99213 near me?"
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Frequently asked questions
About Presbyterian Health Plan's price transparency data.
What price transparency data does Presbyterian Health Plan publish?
Presbyterian Health Plan's August 2026 Transparency in Coverage files list 1 plans, 22K providers (NPIs), 2.4K tax IDs and 3.6K billing codes, for 190K negotiated rate rows in total.
Which states does Presbyterian Health Plan's network cover?
Presbyterian Health Plan's files include providers in 51 states. The states with the most in-network providers are New Mexico, Texas, Colorado, Arizona, California.
How often is Presbyterian Health Plan's data updated?
Payers must post updated machine-readable files every month. PayerPrice processes Presbyterian Health Plan's files monthly; the latest processed release is August 2026, and 15 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 Presbyterian Health Plan's negotiated rates?
Start a free PayerPrice trial to search Presbyterian Health Plan'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.