get_negotiated_rate

Get Negotiated Rate

What it answers

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.

Inputs

code

string · required

Billing code (CPT/HCPCS), e.g. '99213'.

npi

string · required

10-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.

payer

string · required

Payer name or alias (e.g. 'cigna', 'aetna', 'uhc'). Must be a built payer; use find_data_sources or coverage_status to see which are available.

methodology

any · optional

Optional: narrow to ONE methodology (negotiated / percentage / per_diem / case_rate). Methodologies are NOT comparable — don't mix them.

default: null

state

any · optional

2-letter state, e.g. 'CA'. STRONGLY RECOMMENDED: resolution is state-scoped — without it you will usually get no_match.

default: null

vintage

any · optional

Optional 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.

default: null

Call it

From an agent: connect the Vlada MCP once (one click for Claude, ChatGPT, Cursor, VS Code) and ask in plain English; the agent selects get_negotiated_rate when the question fits. From code: the same tool over REST with an API key. The schema endpoint needs no key.

curl -X POST https://api.vladahealth.com/v1/tools/get_negotiated_rate \
  -H "Authorization: Bearer $VLADA_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{"code":"<code>","npi":"<npi>","payer":"<payer>"}'

curl https://api.vladahealth.com/v1/tools/get_negotiated_rate/schema      # the JSON schema, no auth
# MCP endpoint (Streamable HTTP): https://mcp.vladahealth.com/mcp

What comes back

Typed rows plus provenance on every answer: the public source file, its vintage, the methodology, and a response_hash you can replay. Prove and replay tools turn any number into a re-runnable receipt. A number the data cannot support comes back as “not in the data”, never as zero.

Output schema

{
 "$defs": {
  "Quality": {
   "description": "Row-level quality signal. All flags precomputed at build time\n(stored on the gold mart) and passed through here.",
   "properties": {
    "is_outlier": {
     "default": false,
     "title": "Is Outlier",
     "type": "boolean"
    },
    "is_ghost_candidate": {
     "default": false,
     "title": "Is Ghost Candidate",
     "type": "boolean"
    },
    "n_similar_rates": {
     "default": 0,
     "title": "N Similar Rates",
     "type": "integer"
    },
    "confidence": {
     "default": 1,
     "title": "Confidence",
     "type": "number"
    }
   },
   "title": "Quality",
   "type": "object"
  },
  "Source": {
   "description": "Cell-level provenance. Every served value traces back here.\n\n`snapshot_id` is the Iceberg snapshot the tool read from. Two calls\nat the same snapshot MUST produce byte-identical responses —\nthat's the content-addressed caching guarantee.",
   "properties": {
    "table": {
     "title": "Table",
     "type": "string"
    },
    "rate_id": {
     "anyOf": [
      {
       "type": "string"
      },
      {
       "type": "null"
      }
     ],
     "default": null,
     "title": "Rate Id"
    },
    "source_files": {
     "items": {
      "type": "string"
     },
     "title": "Source Files",
     "type": "array"
    },
    "snapshot_id": {
     "anyOf": [
      {
       "type": "integer"
      },
      {
       "type": "null"
      }
     ],
     "default": null,
     "title": "Snapshot Id"
    }
   },
   "required": [
    "table"
   ],
   "title": "Source",
   "type": "object"
  }
 },
 "properties": {
  "value": {
   "default": null,
   "title": "Value"
  },
  "unit": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Unit"
  },
  "vintage": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Vintage"
  },
  "source": {
   "$ref": "#/$defs/Source"
  },
  "methodology": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Methodology"
  },
  "quality": {
   "$ref": "#/$defs/Quality"
  },
  "invariants_applied": {
   "items": {
    "type": "string"
   },
   "title": "Invariants Applied",
   "type": "array"
  },
  "caveats": {
   "items": {
    "type": "string"
   },
   "title": "Caveats",
   "type": "array"
  },
  "response_hash": {
   "default": "",
   "title": "Response Hash",
   "type": "string"
  },
  "semantic_version": {
   "default": 1,
   "title": "Semantic Version",
   "type": "integer"
  },
  "tool_version": {
   "default": "unknown",
   "title": "Tool Version",
   "type": "string"
  },
  "explanation": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Explanation"
  },
  "status": {
   "default": "complete",
   "title": "Status",
   "type": "string"
  },
  "refusal": {
   "anyOf": [
    {
     "additionalProperties": true,
     "type": "object"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Refusal"
  },
  "failure": {
   "anyOf": [
    {
     "additionalProperties": true,
     "type": "object"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Failure"
  },
  "as_of": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "As Of"
  },
  "freshness_state": {
   "default": "unknown",
   "title": "Freshness State",
   "type": "string"
  },
  "facility_resolved_to": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Facility Resolved To"
  },
  "payer_resolved_to": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Payer Resolved To"
  },
  "code_resolved_to": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Code Resolved To"
  },
  "rate_id": {
   "anyOf": [
    {
     "type": "string"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "Rate Id"
  },
  "no_match": {
   "anyOf": [
    {
     "additionalProperties": true,
     "type": "object"
    },
    {
     "type": "null"
    }
   ],
   "default": null,
   "title": "No Match"
  }
 },
 "title": "RateResponse",
 "type": "object"
}

Sources behind it

vlada_curated.fact_rate
vlada_curated.idx_rate_lookup

tables: vlada_curated.fact_rate · vlada_curated.idx_rate_lookup

Known limits

state required for resolution
medical_mutual not yet indexed

As of the 2026-09-19 build of the served surface · machine-readable catalog · the live server may run a different version; the schema endpoint above is authoritative for what is deployed.