Estimate Costs for a Procedure

Endpoint for estimating costs associated with a given procedure / procedure bundle


Description: The procedure cost estimate endpoint calculates estimated costs for a given procedure based on a user's location.

Endpoint: /v1/procedure_cost_estimate

Status: Live

Methods: GET

Example use-case: Estimate the cost of a knee replacement surgery for a user in Boston so they can plan their personal finances accordingly.


Power through the Procedures Reference Endpoint

Leverage the /v1/procedures endpoint to search for and see all relevant codes for a procedure or bundle.

Diving In

Use this endpoint to show users cost estimates across the most common "shoppable" procedures.


Sources of Cost Estimate data

Estimates can either be insurance-specific, through Price Transparency data, or through aggregated claims.

Users will indicate which data source should be queried through the type parameter.

Request Parameters

comma separated uuid listList of exact procedure uuids61288975-67ad-4b1f-97d6-e1a6bc00afd3,fbb223e6-9806-45b5-95b1-4d7a36cc9164
typeprice_transparency, claimsThe type of product to pull from, the claims-based product or the payer-filed-price transparency product.
(default: claims)
stringZip code60606
plan_idstringExact insurance plan ID for negotiated rate with provider.
(can be retrieved from insurances endpoint). Necessary only if searching for 'price_transparency' powered estimates.

Example Request

This endpoint will only use price transparency data if type=price_transparency parameter is set.

curl -X GET \
      &member_zip=10011&type=price_transparency&plan_id=2d5231c0-2d29-4026-9138-5dcbd0591404' \
  -H 'authorization: Bearer your_token'

Example JSON Output

See below for an example JSON output for the call above. Median, minimum, and maximum values are displayed for the procedure's cost estimation.

    "parameters": {
        "procedures": [
                "uuid": "00000000-0000-0000-0000-000000000000",
                "display": "MRI scan of lower spinal canal"
        "member_zip": "60606",
        "type": "price_transparency",
        "insurance": "2d5231c0-2d29-4026-9138-5dcbd0591404"
    "data": {
        "cost_estimates": {
            "minimum": 100.00,
            "median": 300.00,
            "maximum": 500.00