{"uid":"cap_wTY2n41z106HMzihEtPgE","slug":"hospital-negotiated-payer-prices-by-billing-code-1536c2d6","name":"Hospital Negotiated Payer Prices by Billing Code","description":"Negotiated prices for one billing code in one area, per canonical payer and plan 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negotiated prices for a single billing code across payers and plan types in a specified US location","exampleAgentPrompt":"What do different insurance plan types negotiate for CPT code 99213 within 25 miles of ZIP 90210? Show me commercial, Medicare Advantage, and Medicaid rates.","exampleUseCases":[{"title":"Patient cost research before procedure","prompt":"I'm having an outpatient knee arthroscopy soon — CPT code 29881. Can you look up what commercial insurance plans typically pay for that within 30 miles of ZIP 30301?"},{"title":"Healthcare analyst payer rate comparison","prompt":"Pull the negotiated rates for MS-DRG 470 (major joint replacement) near lat 40.71, lon -74.01 across all plan types — I want to see how Medicare Advantage compares to commercial plans."},{"title":"Benefits consultant benchmarking tool","prompt":"What are the typical negotiated hospital prices for HCPCS code G0439 in the outpatient setting within 50 miles of ZIP 60601, broken down by payer?"}],"resultDescription":"Returns a structured object containing the billing code metadata (type, description, DRG info if applicable), location context, applied filters, total number of payers with prices, and a list of payers with their negotiated rates broken down by plan type. Includes aggregate stats like how many hospitals have prices and how many MRF files were scanned.","failureModes":["Missing required 'code' query parameter returns validation error","Invalid code format (not 3-5 alphanumeric chars) rejected by schema","No hospitals with price data found for the given area/radius returns empty payers list","Overly small radius with sparse data may yield zero results","Invalid ZIP code format (non-5-digit) rejected","Lat/lon out of valid range rejected","Payment not fulfilled triggers 402 response before data is returned"],"whenToPreferThis":"Use this endpoint when you need payer-level negotiated price breakdowns for a specific billing code in a geographic area — especially when comparing plan types (commercial, Medicare Advantage, Medicaid, etc.) across multiple hospitals. Prefer this over the raw hospital-price endpoint when your goal is payer and plan-type aggregation rather than per-hospital posted chargemaster prices. Ideal for benefits analysis, cost benchmarking, and insurance rate research workflows.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-10-22T12:40:37.912Z","isFirstParty":false,"canonicalSlug":"hospital-negotiated-payer-prices-by-billing-code-1536c2d6"}