Get in-network contracted rates

curl --request POST \
  --url https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network \
  --header 'Content-Type: application/json' \
  --header 'X-API-Key: <api-key>' \
  --data '
{
  "npis": [
    "1043566623",
    "1972767655"
  ],
  "planId": "942404110",
  "conditionCode": "99214",
  "codeType": "CPT"
}
'

{
  "data": {
    "1043566623": [
      {
        "code": "99214",
        "codeType": "CPT",
        "negotiatedPrices": [
          {
            "negotiatedRate": 65.87,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "123456789"
          },
          {
            "negotiatedRate": 128.45,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "123456789"
          },
          {
            "negotiatedRate": 142.1,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 189.5,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "22"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "987654321"
          },
          {
            "negotiatedRate": 213.75,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 266.88,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "123456789"
          }
        ],
        "summary": {
          "minRate": 65.87,
          "maxRate": 266.88,
          "avgRate": 147.03,
          "instances": 6
        }
      }
    ],
    "1972767655": [
      {
        "code": "99214",
        "codeType": "CPT",
        "negotiatedPrices": [
          {
            "negotiatedRate": 104.46,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 108.22,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 112.88,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "22"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 115.9,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 119.33,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 123.45,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 135.67,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 169.37,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          }
        ],
        "summary": {
          "minRate": 104.46,
          "maxRate": 169.37,
          "avgRate": 117.78,
          "instances": 8
        }
      }
    ]
  },
  "meta": {
    "planId": "942404110",
    "planName": "UHC Choice Plus POS",
    "payer": "UNH",
    "requestId": "req_cf7f67790f92",
    "timestamp": "2025-06-15T23:15:48.734729Z",
    "processingTimeMs": 912,
    "inNetworkRecordsCount": 14
  }
}

Pricing

Get in-network contracted rates

Retrieve contracted rates for healthcare providers (NPIs) for specific billing codes and insurance plans.

This endpoint supports bulk lookups for up to 50 NPIs per request, enabling efficient pricing discovery across multiple providers simultaneously.

Supported Rate Types

Fee-for-Service (FFS) – Per-procedure contracted rates
Capitated – Monthly per-member rates (coming soon)
Bundled – Episode-based payment models (coming soon)

Use Cases

Care navigation and provider comparison
Patient cost estimation and transparency
Network adequacy analysis
Provider directory integration
Contracting and compliance analysis

POST

pricing

in-network

Get in-network contracted rates

curl --request POST \
  --url https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network \
  --header 'Content-Type: application/json' \
  --header 'X-API-Key: <api-key>' \
  --data '
{
  "npis": [
    "1043566623",
    "1972767655"
  ],
  "planId": "942404110",
  "conditionCode": "99214",
  "codeType": "CPT"
}
'

{
  "data": {
    "1043566623": [
      {
        "code": "99214",
        "codeType": "CPT",
        "negotiatedPrices": [
          {
            "negotiatedRate": 65.87,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "123456789"
          },
          {
            "negotiatedRate": 128.45,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "123456789"
          },
          {
            "negotiatedRate": 142.1,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 189.5,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "22"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "987654321"
          },
          {
            "negotiatedRate": 213.75,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 266.88,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "123456789"
          }
        ],
        "summary": {
          "minRate": 65.87,
          "maxRate": 266.88,
          "avgRate": 147.03,
          "instances": 6
        }
      }
    ],
    "1972767655": [
      {
        "code": "99214",
        "codeType": "CPT",
        "negotiatedPrices": [
          {
            "negotiatedRate": 104.46,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 108.22,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 112.88,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "22"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 115.9,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 119.33,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 123.45,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          },
          {
            "negotiatedRate": 135.67,
            "expirationDate": "2024-12-31",
            "serviceCodes": [
              "11"
            ],
            "billingClass": "professional",
            "negotiatedType": "negotiated",
            "tinType": "EIN",
            "tinValue": "555666777"
          },
          {
            "negotiatedRate": 169.37,
            "expirationDate": null,
            "serviceCodes": [],
            "billingClass": null,
            "negotiatedType": "negotiated",
            "tinType": null,
            "tinValue": null
          }
        ],
        "summary": {
          "minRate": 104.46,
          "maxRate": 169.37,
          "avgRate": 117.78,
          "instances": 8
        }
      }
    ]
  },
  "meta": {
    "planId": "942404110",
    "planName": "UHC Choice Plus POS",
    "payer": "UNH",
    "requestId": "req_cf7f67790f92",
    "timestamp": "2025-06-15T23:15:48.734729Z",
    "processingTimeMs": 912,
    "inNetworkRecordsCount": 14
  }
}

Authorizations

X-API-Key

string

header

required

Your API key for authentication. Include this header in all requests.

Note: When using the API Gateway (care-navigation-gateway-ccg16t89.wl.gateway.dev), use query parameter authentication instead: ?key=YOUR_API_KEY

Get your API key by reaching out to [email protected].

Body

application/json

npis

string[]

required

List of National Provider Identifiers (NPIs) to lookup pricing for

Required array length: 1 - 50 elements

10-digit National Provider Identifier

Example:

["1043566623", "1972767655"]

conditionCode

string

required

Medical billing code to retrieve pricing for

Example:

"99214"

planId

string

default:942404110

Insurance plan identifier. Accepts:

EIN (Employer Identification Number) for self-funded plans
HIOS ID (Health Insurance Oversight System) for marketplace plans
Custom Plan ID for proprietary plan identification

Example:

"942404110"

codeType

enum<string>

default:CPT

Medical billing code standard:

CPT: Current Procedural Terminology
NDC: National Drug Code
HCPCS: Healthcare Common Procedure Coding System
ICD: International Classification of Diseases
DRG: Diagnosis Related Group (various types)
APC: Ambulatory Payment Classification
CDT: Current Dental Terminology

Available options:

CPT,

NDC,

HCPCS,

RC,

ICD,

MS-DRG,

R-DRG,

S-DRG,

APS-DRG,

AP-DRG,

APR-DRG,

APC,

LOCAL,

EAPG,

HIPPS,

CDT,

CSTM-ALL

Example:

"CPT"

Response

Successful pricing lookup

data

object

required

Pricing data organized by NPI, with each NPI containing an array of rate objects grouped by negotiated type

Show child attributes

data.{key}

object[]

Show child attributes

data.{key}.code

string

required

The billing code that was requested

Example:

"99214"

data.{key}.codeType

enum<string>

default:CPT

required

Medical billing code standard:

CPT: Current Procedural Terminology
NDC: National Drug Code
HCPCS: Healthcare Common Procedure Coding System
ICD: International Classification of Diseases
DRG: Diagnosis Related Group (various types)
APC: Ambulatory Payment Classification
CDT: Current Dental Terminology

Available options:

CPT,

NDC,

HCPCS,

RC,

ICD,

MS-DRG,

R-DRG,

S-DRG,

APS-DRG,

AP-DRG,

APR-DRG,

APC,

LOCAL,

EAPG,

HIPPS,

CDT,

CSTM-ALL

Example:

"CPT"

data.{key}.negotiatedPrices

object[]

required

Array of individual negotiated price details

Show child attributes

data.{key}.negotiatedPrices.negotiatedRate

number<float>

required

Individual negotiated rate amount

Required range: x >= 0

Example:

128.8

data.{key}.negotiatedPrices.negotiatedType

enum<string>

required

Nature of the rate:

negotiated: Contractually agreed dollar amount
derived: Internally calculated rate
fee_schedule: Published fee schedule rate
percentage: Percentage of billed charges
per_diem: Daily rate (e.g., room & board)

Available options:

negotiated,

derived,

fee_schedule,

percentage,

per_diem

Example:

"negotiated"

data.{key}.negotiatedPrices.expirationDate

string<date> | null

Date when this negotiated rate expires (ISO 8601 format). Null if no expiration date specified.

Example:

"2024-12-31"

data.{key}.negotiatedPrices.serviceCodes

string[]

Array of two-digit CMS Place of Service codes that identify where medical services are provided. Common codes include: 11 (Office), 21 (Inpatient Hospital), 22 (Outpatient Hospital), 23 (Emergency Room).

Example:

["11", "22"]

data.{key}.negotiatedPrices.billingClass

string | null

Billing class or classification for this rate. Null if not specified.

Example:

"professional"

data.{key}.negotiatedPrices.tinType

string | null

Tax Identification Number type (e.g., "EIN", "SSN"). Null if not specified.

Example:

"EIN"

data.{key}.negotiatedPrices.tinValue

string | null

Tax Identification Number value. Null if not specified.

Example:

"123456789"

data.{key}.summary

object

required

Summary statistics for all negotiated rates

Show child attributes

data.{key}.summary.minRate

number<float>

required

Minimum negotiated rate amount found

Required range: x >= 0

Example:

128.8

data.{key}.summary.maxRate

number<float>

required

Maximum negotiated rate amount found

Required range: x >= 0

Example:

151.53

data.{key}.summary.avgRate

number<float>

required

Average negotiated rate amount

Required range: x >= 0

Example:

140.16

data.{key}.summary.instances

integer

required

Number of negotiated rate records found

Required range: x >= 0

Example:

5

Overview

API Documentation

API Endpoints

Get in-network contracted rates

Supported Rate Types

Use Cases

Authorizations

Body

Response