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Get Negotiated Rate

get_negotiated_rate
Read-onlyIdempotent

Get the negotiated rate a specific payer pays a specific NPI for a specific billing code, in a state. Resolves at query time through the canonical graph + inverted indexes (no precomputed edge table) and returns the most provider-specific rate with source lineage, methodology, evidence type, and Medicare-PUF corroboration. UHC custom codes are resolved automatically. Covers all built payers. Near-zero dollar rates (positive, under $1 — the ghost class the benchmark path excludes) are never picked over a plausible rate; if one is all that matched, it is served flagged is_ghost_candidate at confidence 0.2 with a caveat, never as a real price.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
npiYes10-digit provider NPI. This is the INSURER / Transparency-in-Coverage side — rates are keyed by NPI (Type 1 individual OR Type 2 facility/org), NOT by CCN.
codeYesBilling code (CPT/HCPCS), e.g. '99213'.
payerYesPayer name or alias (e.g. 'cigna', 'aetna', 'uhc'). Must be a built payer; use find_data_sources to see which are available.
stateNo2-letter state, e.g. 'CA'. STRONGLY RECOMMENDED: resolution is state-scoped — without it you will usually get no_match.
vintageNoOptional payer data-build version (e.g. '2026-04'). Omit = latest built; for claim repricing, pin to the claim's service-date vintage to avoid a silent mismatch.
methodologyNoOptional: narrow to ONE methodology (negotiated / percentage / per_diem / case_rate). Methodologies are NOT comparable — don't mix them.

Output Schema

TableJSON Schema
NameRequiredDescriptionDefault
unitNo
as_ofNo
valueNo
sourceNo
statusNocomplete
caveatsNo
failureNo
qualityNo
rate_idNo
refusalNo
vintageNo
no_matchNo
explanationNo
methodologyNo
tool_versionNounknown
response_hashNo
freshness_stateNounknown
code_resolved_toNo
semantic_versionNo
payer_resolved_toNo
invariants_appliedNo
facility_resolved_toNo

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