estimate_procedure_cost
Returns the typical allowed-amount range (low, median, high) for one medical procedure in one US state, the usual billing components (facility, physician, anesthesia, pathology), and the data vintage. If the user chooses to give their own deductible, coinsurance and out-of-pocket figures, it also returns an estimated patient share. These are estimates of typical prices from hospital price transparency and Medicare data, not quotes. Only the procedure and state are required; ZIP code and plan figures are optional and are used only for this one calculation.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| state | Yes | 2-letter US state code, e.g. 'CT'. Prices are state-level. | |
| zip_code | No | Optional 5-digit ZIP, used only to refine the local estimate | |
| plan_type | No | Insurance plan type (default commercial) | |
| procedure | Yes | Procedure slug or plain name, e.g. 'colonoscopy' or 'mri-knee'. A plain name that is not an exact slug can be matched with resolve_procedure. | |
| oop_remaining | No | Dollars left to the member's out-of-pocket max | |
| coinsurance_pct | No | Coinsurance percentage, e.g. 20 for 20% | |
| deductible_remaining | No | Dollars left on the member's deductible |