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Payer price transparency data
QualChoice
QualChoice is a health insurer, part of the Centene Group family. They report 360 insurance plans covering 14K providers across 4.9K billing codes.
Source: public Transparency in Coverage filesRefreshed monthly, latest September 202618 monthly releases tracked
Monthly release
360
Plans
14K
Providers (NPIs)
XX% vs prior month
2.8K
Tax IDs
XX% vs prior month
4.9K
Billing codes
XX% vs prior month
230K
Rate rows
XX% vs prior month
September 2026 release
What's in QualChoice's data
A profile of the machine-readable files QualChoice publishes, after PayerPrice parses and normalizes them.
Billing code types
Distinct codes and rate rows by code system
CodesRows
- RC160200K89%
- CPT3.6K22K9.8%
- HCPCS8402.6K1.2%
- MS-DRG3301K0.4%
Billing class
Professional vs. institutional rate rows
- Institutional200K89%
- Professional25K11%
Negotiation arrangement
How each rate is expressed
- Negotiated230K100%
- Percentage38<0.1%
- Per Diem33<0.1%
- Fee Schedule4<0.1%
Plan identifiers
HIOS IDs mark individual and small-group plans; EINs mark employer plans
- HIOS ID31085%
- EIN5615%
Providers by type
Distinct NPIs by entity type
- Individual (Type 1)14K95%
- Organization (Type 2)6604.6%
Tax IDs by type
How provider groups are identified
- EIN2.8K100%
Top states
States with the most providers in network
- Arkansas12K
- Texas410
- Missouri190
- Tennessee150
- Oklahoma140
- Florida91
Top specialties
Provider taxonomies with the most NPIs
- Family Nurse Practitioner1.6K
- Family Medicine Physician1.2K
- Physical Therapist770
- Certified Registered Nurse Anesthetist640
- Internal Medicine Physician510
- Emergency Medicine Physician440
These are the files. Want the rates inside them?
Look up QualChoice'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 | 360 | 14K | 2.8K | 4.9K | 230K |
| August 2026 | 360 | 15K | 3.4K | 4.9K | 210K |
| July 2026 | 360 | 15K | 3.3K | 4.9K | 210K |
| June 2026 | — | — | — | — | |
| May 2026 | — | — | — | — |
Data quality scorecard
5/6Good
This payer scores 5/6 on data quality (Good). Areas that don't meet the threshold: standard code coverage.
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
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
QualChoice'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 QualChoice pay for CPT 99213 near me?"
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Frequently asked questions
About QualChoice's price transparency data.
What price transparency data does QualChoice publish?
QualChoice's September 2026 Transparency in Coverage files list 360 plans, 14K providers (NPIs), 2.8K tax IDs and 4.9K billing codes, for 230K negotiated rate rows in total.
Which states does QualChoice's network cover?
QualChoice's files include providers in 49 states. The states with the most in-network providers are Arkansas, Texas, Missouri, Tennessee, Oklahoma.
How often is QualChoice's data updated?
Payers must post updated machine-readable files every month. PayerPrice processes QualChoice'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 QualChoice's negotiated rates?
Start a free PayerPrice trial to search QualChoice'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.