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Hospital Price Benchmark (Medicare Reference Prices)
x402
Hospital Price Benchmark (Medicare Reference Prices) is a paid API for AI agents from payai.agentstools.dev, paid per call via x402, $0.01/call, status unknown (last checked 2026-09-15).
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.
Price / call$0.01
Success—
StatusUnknown
How this service works
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.
Output
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.
Example use cases
Hospital bill price comparison
“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?”
Insurance negotiation anchor for outpatient procedure
“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.”
Healthcare cost transparency tool
“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.”
Technical details
Endpoint
GEThttps://payai.agentstools.dev/price/benchmarkWhen to prefer
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.
Side effects
- 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
Input
Schema · Request body
| Field | Type | Description |
|---|---|---|
| inputrequired | object | |
| output | object |
Tags
x402
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