Skip to main content
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

​
meta
object
required