Payer TiC Negotiated Rate Lookup

An independent tool. It is not affiliated with, endorsed by, or operated by any health insurer, payer, issuer or plan sponsor whose files it reads. All data is read live from each payer's own federally mandated Transparency-in- Coverage machine-readable file, never scraped from any member-facing site.

Give it a payer's own table-of-contents URL, a plan (by name or plan ID), and a CPT/HCPCS procedure code; get back the actual negotiated rate that insurer pays in-network for that procedure under that plan -- the number the No Surprises Act's Transparency in Coverage rule (45 CFR 147.212) requires every US health plan and issuer to publish, and which almost nobody can otherwise read.

Why this is hard, and why that is the point

A payer's own machine-readable files are not small. Anthem's national table-of-contents file alone measured 9.3 GB (gzip-compressed) on 2026-08-22; the in-network-rates files it links to are, per CMS's own published guidance, "as large as one Terabyte" each. No ordinary tool downloads that. This Actor never tries to: it stream-parses straight to the one plan and one procedure code you asked for, discarding everything else as it reads, so a lookup that would otherwise require downloading and holding a file bigger than most laptops' RAM completes as a bounded scan with a disclosed byte budget (max_scan_mb).

What it returns

For each query: payer_label (read from the payer's own file, never from your input), plan_label, the procedure_code/code_type you asked about, billing_class (professional/institutional), negotiated_rate, negotiated_type, an in_network_provider_npi_count (how many distinct in-network providers this rate applies to -- never the providers' identities), and effective_date. Every result also carries scan_complete, so you can tell "this plan has no rate for this code" apart from "the file is too large to have finished checking within the scan budget you set" -- two very different findings.

What it does not return, on purpose

No individual provider's NPI, name or TIN, and no raw file contents. An NPI Type 1 record identifies a single practicing clinician -- a natural person -- so only an aggregate count ever leaves this Actor, never the identifiers themselves.

Finding a payer's table-of-contents URL

Every payer publishes one on its own public Transparency-in-Coverage / "machine-readable files" page (search "<payer name> transparency in coverage machine readable files"). There is no central registry across payers -- that absence is itself part of why this lookup is worth doing instead of reading the number off a bill.