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"
}
'

import requests

url = "https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network"

payload = {
    "npis": ["1043566623", "1972767655"],
    "planId": "942404110",
    "conditionCode": "99214",
    "codeType": "CPT"
}
headers = {
    "X-API-Key": "<api-key>",
    "Content-Type": "application/json"
}

response = requests.post(url, json=payload, headers=headers)

print(response.text)

const options = {
  method: 'POST',
  headers: {'X-API-Key': '<api-key>', 'Content-Type': 'application/json'},
  body: JSON.stringify({
    npis: ['1043566623', '1972767655'],
    planId: '942404110',
    conditionCode: '99214',
    codeType: 'CPT'
  })
};

fetch('https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network', options)
  .then(res => res.json())
  .then(res => console.log(res))
  .catch(err => console.error(err));

<?php

$curl = curl_init();

curl_setopt_array($curl, [
  CURLOPT_URL => "https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network",
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => "",
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 30,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => "POST",
  CURLOPT_POSTFIELDS => json_encode([
    'npis' => [
        '1043566623',
        '1972767655'
    ],
    'planId' => '942404110',
    'conditionCode' => '99214',
    'codeType' => 'CPT'
  ]),
  CURLOPT_HTTPHEADER => [
    "Content-Type: application/json",
    "X-API-Key: <api-key>"
  ],
]);

$response = curl_exec($curl);
$err = curl_error($curl);

curl_close($curl);

if ($err) {
  echo "cURL Error #:" . $err;
} else {
  echo $response;
}

package main

import (
	"fmt"
	"strings"
	"net/http"
	"io"
)

func main() {

	url := "https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network"

	payload := strings.NewReader("{\n  \"npis\": [\n    \"1043566623\",\n    \"1972767655\"\n  ],\n  \"planId\": \"942404110\",\n  \"conditionCode\": \"99214\",\n  \"codeType\": \"CPT\"\n}")

	req, _ := http.NewRequest("POST", url, payload)

	req.Header.Add("X-API-Key", "<api-key>")
	req.Header.Add("Content-Type", "application/json")

	res, _ := http.DefaultClient.Do(req)

	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)

	fmt.Println(string(body))

}

HttpResponse<String> response = Unirest.post("https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network")
  .header("X-API-Key", "<api-key>")
  .header("Content-Type", "application/json")
  .body("{\n  \"npis\": [\n    \"1043566623\",\n    \"1972767655\"\n  ],\n  \"planId\": \"942404110\",\n  \"conditionCode\": \"99214\",\n  \"codeType\": \"CPT\"\n}")
  .asString();

require 'uri'
require 'net/http'

url = URI("https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network")

http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true

request = Net::HTTP::Post.new(url)
request["X-API-Key"] = '<api-key>'
request["Content-Type"] = 'application/json'
request.body = "{\n  \"npis\": [\n    \"1043566623\",\n    \"1972767655\"\n  ],\n  \"planId\": \"942404110\",\n  \"conditionCode\": \"99214\",\n  \"codeType\": \"CPT\"\n}"

response = http.request(request)
puts response.read_body

{
  "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"
}
'

import requests

url = "https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network"

payload = {
    "npis": ["1043566623", "1972767655"],
    "planId": "942404110",
    "conditionCode": "99214",
    "codeType": "CPT"
}
headers = {
    "X-API-Key": "<api-key>",
    "Content-Type": "application/json"
}

response = requests.post(url, json=payload, headers=headers)

print(response.text)

const options = {
  method: 'POST',
  headers: {'X-API-Key': '<api-key>', 'Content-Type': 'application/json'},
  body: JSON.stringify({
    npis: ['1043566623', '1972767655'],
    planId: '942404110',
    conditionCode: '99214',
    codeType: 'CPT'
  })
};

fetch('https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network', options)
  .then(res => res.json())
  .then(res => console.log(res))
  .catch(err => console.error(err));

<?php

$curl = curl_init();

curl_setopt_array($curl, [
  CURLOPT_URL => "https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network",
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => "",
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 30,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => "POST",
  CURLOPT_POSTFIELDS => json_encode([
    'npis' => [
        '1043566623',
        '1972767655'
    ],
    'planId' => '942404110',
    'conditionCode' => '99214',
    'codeType' => 'CPT'
  ]),
  CURLOPT_HTTPHEADER => [
    "Content-Type: application/json",
    "X-API-Key: <api-key>"
  ],
]);

$response = curl_exec($curl);
$err = curl_error($curl);

curl_close($curl);

if ($err) {
  echo "cURL Error #:" . $err;
} else {
  echo $response;
}

package main

import (
	"fmt"
	"strings"
	"net/http"
	"io"
)

func main() {

	url := "https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network"

	payload := strings.NewReader("{\n  \"npis\": [\n    \"1043566623\",\n    \"1972767655\"\n  ],\n  \"planId\": \"942404110\",\n  \"conditionCode\": \"99214\",\n  \"codeType\": \"CPT\"\n}")

	req, _ := http.NewRequest("POST", url, payload)

	req.Header.Add("X-API-Key", "<api-key>")
	req.Header.Add("Content-Type", "application/json")

	res, _ := http.DefaultClient.Do(req)

	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)

	fmt.Println(string(body))

}

HttpResponse<String> response = Unirest.post("https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network")
  .header("X-API-Key", "<api-key>")
  .header("Content-Type", "application/json")
  .body("{\n  \"npis\": [\n    \"1043566623\",\n    \"1972767655\"\n  ],\n  \"planId\": \"942404110\",\n  \"conditionCode\": \"99214\",\n  \"codeType\": \"CPT\"\n}")
  .asString();

require 'uri'
require 'net/http'

url = URI("https://care-navigation-gateway-ccg16t89.wl.gateway.dev/pricing/in-network")

http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true

request = Net::HTTP::Post.new(url)
request["X-API-Key"] = '<api-key>'
request["Content-Type"] = 'application/json'
request.body = "{\n  \"npis\": [\n    \"1043566623\",\n    \"1972767655\"\n  ],\n  \"planId\": \"942404110\",\n  \"conditionCode\": \"99214\",\n  \"codeType\": \"CPT\"\n}"

response = http.request(request)
puts response.read_body

{
  "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 support@docaroo.com.

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

Pattern: ^[0-9]{10}$

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

Overview

API Documentation

API Endpoints

Get in-network contracted rates

Supported Rate Types

Use Cases

Authorizations

Body

Response