{"uid":"cap_K_OEmlS7YvpSr6N471LmL","slug":"medicare-national-reference-price-benchmark-by-procedure-code-5998efca","name":"Medicare National Reference Price Benchmark by Procedure Code","description":"Medicare national reference price for a procedure code — a cheap anchor to compare hospital prices against. Returns the average Medicare submitted, allowed and payment amounts per place of service from CMS public data. Informational.","url":"https://api.agentstools.dev/price/benchmark","method":"GET","headers":{},"bodySchema":{"type":"object","$schema":"https://json-schema.org/draft/2020-12/schema","required":["input"],"properties":{"input":{"type":"object","required":["type","method"],"properties":{"type":{"type":"string","const":"http"},"method":{"enum":["GET","HEAD","DELETE"],"type":"string"},"queryParams":{"type":"object","required":["code"],"properties":{"code":{"type":"string","description":"Procedure billing code, e.g. 99213"},"code_type":{"type":"array","items":{"enum":["CPT","HCPCS","MS-DRG","DRG","APC","NDC","ICD-10","CDM","local"],"type":"string"},"description":"Billing-code system; national benchmark supports CPT and HCPCS"}}}},"additionalProperties":false},"output":{"type":"object","required":["type"],"properties":{"type":{"type":"string"},"example":{"type":"object"}}}}},"responseSchema":null,"example":null,"exampleRequest":null,"tags":["x402"],"displayCostAmount":"0.01","displayCostAsset":"USDC","priceDynamic":false,"priceHint":null,"priceStatus":"priced","priceSource":"probe","requiresHandshake":false,"reviewCount":0,"rating":{"score":"0.00","successRate":"0.00","reviews":0,"stars":null,"state":"unrated"},"availabilityStatus":"unknown","priceObserved":null,"sessionDeposit":null,"pricing":{"kind":"static","summary":"$0.01/call","primary":{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.01","per":"call","confidence":"exact"},"accepted":[{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.01","per":"call","confidence":"exact"}]},"paymentMethods":[{"uid":"pm_ojxhKIgveegpJ6DGIP1a_","protocol":"x402","methodType":"crypto","chain":"base","mode":"charge","costAmount":"0.01","costPer":"request","priority":0,"asset":"0x833589fCD6eDb6E08f4c7C32D4f71b54bdA02913","unit":"request","depositMicros":null,"planRef":null}],"brandName":null,"brandSlug":null,"brandBaseUrl":null,"brandDocsUrl":null,"whatItDoes":"Returns CMS public Medicare submitted, allowed, and payment amounts for a procedure code by place of service, as a national benchmark for comparing hospital prices.","exampleAgentPrompt":"What's the Medicare national benchmark price for CPT code 99213 — show me the submitted, allowed, and payment amounts by place of service so I can compare it against a hospital's billed rate.","exampleUseCases":null,"resultDescription":"Returns average Medicare submitted, allowed, and payment amounts for the given procedure code, broken down by place of service, sourced from CMS public data. Useful as a low-cost anchor reference when evaluating hospital or provider prices.","failureModes":["Unsupported code type (e.g. ICD-10, MS-DRG) — only CPT and HCPCS are supported for national benchmarks","Unknown or invalid procedure code returns empty or null results","Missing required 'code' query parameter returns a 400 validation error","Payment failure (x402) if USDC balance is insufficient"],"whenToPreferThis":"Use this endpoint when you need a quick, cheap ($0.01) national Medicare reference price for a single CPT or HCPCS procedure code. Ideal for healthcare price transparency workflows where you want to anchor or contextualize a hospital's billed price against CMS public data. Prefer this over hospital-specific price lookup endpoints when you need a national benchmark rather than a specific provider's negotiated rate.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-09-15T01:07:11.572Z","isFirstParty":false}