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Applicable Rates

Tools & Resources

Applicable Rates

The Centers for Medicare and Medicaid Services require plans and issuers to publish In-Network Negotiated Rates and Billed Out of Network Allowed Amounts using machine-readable files. A machine-readable file is defined as a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention, while ensuring no semantic meaning is lost. These files are publicly available, but are not necessary intended for member or provider use or interpretation.

Estimate your costs before seeking care

As a health plan member, you have the option to get an estimate before you get the care you need, with the PHP Treatment Cost Estimator. This is available to our individual and employer group plan members. Please log into the myPRES portal, go to Benefits & Coverage, then Estimate My Costs, to access the tool.

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Important for Members: To find out how much you may be charged for a medical procedure or other service you received or plan to receive call Customer Service using the number on the back of your ID Card.

Applicable Rates

In-Network Negotiated RatesBilled Out of Network Allowed Amounts

Machine Readable JSON Reports

Commercial 4-Tier Formulary Individual & Family/Employer Group Metal Plans Formulary Clear Cost Metal Plans Formulary