{"uid":"cap_tI7AbYJWnmjyOfEt6hMeI","slug":"hospital-price-benchmark-medicare-reference-prices-f443d0e5","name":"Hospital Price Benchmark (Medicare Reference Prices)","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://payai.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_LfvhQvubnG7jm3Xh2uPf_","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 Medicare national average submitted, allowed, and payment amounts for a CPT or HCPCS procedure code, broken down by place of service, from CMS public data.","exampleAgentPrompt":"What are the Medicare benchmark prices — submitted, allowed, and payment amounts — for CPT code 99213? I want to compare it against what a hospital is charging me.","exampleUseCases":[{"title":"Hospital bill price comparison","prompt":"I just got a bill from a hospital charging $350 for a standard office visit billed as CPT 99213. What does Medicare typically submit, allow, and pay for that code so I can see if the charge is reasonable?"},{"title":"Insurance negotiation anchor for outpatient procedure","prompt":"I need the Medicare national reference price — submitted, allowed, and actual payment — for HCPCS code G0439 so I can use it as a benchmark when negotiating with my insurer."},{"title":"Healthcare cost transparency tool","prompt":"Can you pull the CMS Medicare average prices for CPT code 27447 — specifically the submitted, allowed, and payment amounts by place of service? I'm building a cost estimate for a knee replacement."}],"resultDescription":"Returns the Medicare national average prices for the requested procedure code, including average submitted amount, allowed amount, and payment amount, segmented by place of service (e.g., facility vs. non-facility), sourced from CMS public data.","failureModes":["Unknown or invalid procedure code returns no results or an error","Code type not supported (only CPT and HCPCS are supported for national benchmark; MS-DRG, APC, etc. may not return data)","CMS data may not include very new or recently deprecated codes","Missing required 'code' query parameter returns a validation error"],"whenToPreferThis":"Use this endpoint when you need a fast, cheap ($0.01) national Medicare reference price to anchor or benchmark against hospital or insurer charges. Prefer this over proprietary pricing databases when you specifically need CMS/Medicare averages rather than commercial payer rates or actual negotiated prices.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-09-15T00:51:03.842Z","isFirstParty":false}