Consumer Pricing API
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Real-time, personalized healthcare prices for conversational AI
Enable consumer AI experiences to answer healthcare’s most unanswerable question:
“What will this procedure cost me?”
Healthcare prices vary too widely for a static average to mean anything, because prices aren’t looked up; they have to be computed. The same procedure can cost two otherwise identical consumers dramatically different amounts — depending on their provider, insurance plan, and where they are in their benefit year.
Turquoise’s Consumer Pricing API computes every price from three layers of precision, delivering an answer specific to that individual.
Identifies the right rates
Powered by Clear Rates™, Turquoise’s proprietary database of millions of negotiated commercial rates — refreshed monthly, cross-verified against what was actually paid, and confidence-scored. For every request, Turquoise selects the exact rate for each procedure, provider, facility, payer, and network combination.
Prices care the way it’s actually billed
Turquoise doesn’t simply price individual billing codes — we apply reimbursement methodologies derived from millions of real claims, reflecting how those codes are actually bundled and paid for in practice.
Applies the consumer’s real benefits
Factors in real-time deductible status, cost sharing, and out-of-pocket limits — so the number reflects what the consumer will actually owe.
Ideal use cases
The Consumer Pricing API powers consumer-facing healthcare experiences that help people understand what they’ll actually pay before receiving care. Whether embedded in conversational AI, care navigation platforms, patient portals, or scheduling workflows, the API delivers personalized, insurance-aware price estimates instead of generic ranges.
One of the highest-impact use cases is the referral and scheduling moment — when a patient has been told they need a procedure and wants to understand what it will actually cost before deciding where to receive care.
Today, the API focuses on the most shoppable healthcare services: medium-to-high-cost procedures where patient responsibility isn’t fixed by a standard copay and provider choice can materially change out-of-pocket costs (e.g., ACL repair, appendectomy, colonoscopy, CT scan, MRI).
| Common use cases | Example prompts |
|---|---|
| Understand the expected cost of a planned procedure | What will a colonoscopy cost me at Inova Fairfax Hospital? |
| Compare expected out-of-pocket costs across providers | Where can I get a biopsy for the lowest out-of-pocket cost? |
| Generate insurance-aware price estimates | How much will my ACL repair cost with my Aetna PPO plan since I haven’t met my deductible? |
| Recommend lower-cost care | Can you recommend an in-network imaging center with a lower out-of-pocket cost? |
What our data covers
Negotiated rates
8.8M
Total prices available in our API.
Services
129
Shoppable services via bundled pricing.
Providers
15K
Total providers across 9 provider types.
Provider types
9
Includes ASC, Hospital, Imaging + more
Payers
90
Total payers with pricing.
Payers with cost share
35
Payers with personalized estimates.
Networks
278
Total payer networks with pricing.
Geographic reach
51
API covers all states + D.C.
Providers
Coverage spans the majority of U.S. hospitals, ambulatory surgery centers, and imaging centers, representing the facilities where patients receive most high-cost outpatient and inpatient care.
Individual clinician pricing is not currently supported. Pricing is calculated at the facility level.
Payers
The Consumer Pricing API supports insurance-aware, member-specific cost estimates for a growing set of commercial health plans. Support continues to expand with each release.
Supported plans include:
- Cigna National OAP
- Anthem CA PPO
- United Healthcare Choice Plus
Outside of the plans with personalized estimates, the API supports pre-benefit pricing for every major national commercial insurer, including UnitedHealthcare, Aetna, Cigna, Elevance Health, Humana, Kaiser Permanente, every Blue Cross Blue Shield licensee, and hundreds of regional health plans and TPAs.
Services
The API covers Turquoise’s complete library of shoppable healthcare services, with a focus on procedures where price transparency has the greatest impact for patients. New services are added with every monthly release, with particular focus on the services required by Transparency in Coverage.
Explore our pricing methodology, data coverage and more
Prospective integration partners can learn more about our underlying pricing methodology, data coverage, and how to get started. Jump to the next page to learn more.