Serif Health Negotiated Rates API

openapi: 3.0.1
info:
  title: Serif Health Pricing API
  description: >-
    REST API for Serif Health's normalized healthcare price-transparency data.
    Query payer-negotiated reimbursement rates and percentile rate distributions
    for an individual procedure code (CPT/DRG), filtered by region, tier, site of
    service, payer, and weighting. Rates are derived from federally mandated
    machine-readable files (MRFs) published by payers and hospitals.

    Only the rates and distributions endpoints are documented here from public
    Serif Health materials. Find Care, Provider Directory, and dataset/extract
    capabilities are offered but their request/response contracts are not publicly
    documented and are intentionally not fabricated here.
  termsOfService: https://www.serifhealth.com/legal/terms
  contact:
    name: Serif Health
    email: hello@serifhealth.com
    url: https://www.serifhealth.com
  version: '1.0'
servers:
  - url: https://pricing-api.serifhealth.com
    description: Serif Health Pricing API
security:
  - ApiKeyAuth: []
paths:
  /v1/rates/code/{code}:
    get:
      operationId: getRatesByCode
      tags:
        - Rates
      summary: Get negotiated rates for a procedure code
      description: >-
        Returns payer-negotiated reimbursement rates for a single procedure code
        (CPT/DRG), optionally filtered by region, tier, site of service, and payer.
      parameters:
        - name: code
          in: path
          required: true
          description: The procedure code (CPT or DRG) to look up.
          schema:
            type: string
          example: '27445'
        - name: region
          in: query
          required: false
          description: US state abbreviation to scope rates to (e.g. PA).
          schema:
            type: string
          example: PA
        - name: tier
          in: query
          required: false
          description: Service tier, e.g. professional or facility.
          schema:
            type: string
          example: professional
        - name: site
          in: query
          required: false
          description: Site of service, e.g. nonfac (non-facility) or fac (facility).
          schema:
            type: string
          example: nonfac
        - name: payer
          in: query
          required: false
          description: Payer name to filter to (e.g. bcbs, cigna, uhc).
          schema:
            type: string
          example: bcbs
      responses:
        '200':
          description: Negotiated rates for the requested code.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/RatesResponse'
        '401':
          description: Missing or invalid API key.
        '404':
          description: No rates found for the requested code/filters.
        '429':
          description: Rate limit exceeded.
  /v1/distributions/code/{code}:
    get:
      operationId: getDistributionsByCode
      tags:
        - Distributions
      summary: Get rate distribution for a procedure code
      description: >-
        Returns the percentile distribution (5th-95th) of negotiated rates for a
        single procedure code, filtered by region, tier, site of service, payer,
        and weighting method.
      parameters:
        - name: code
          in: path
          required: true
          description: The procedure code (CPT or DRG) to look up.
          schema:
            type: string
          example: '90837'
        - name: region
          in: query
          required: false
          description: US state abbreviation to scope the distribution to (e.g. TX).
          schema:
            type: string
          example: TX
        - name: tier
          in: query
          required: false
          description: Service tier, e.g. professional or facility.
          schema:
            type: string
          example: professional
        - name: site
          in: query
          required: false
          description: Site of service, e.g. nonfac (non-facility) or fac (facility).
          schema:
            type: string
          example: nonfac
        - name: payer
          in: query
          required: false
          description: Payer name to filter to (e.g. bcbs, cigna, uhc).
          schema:
            type: string
          example: bcbs
        - name: weighting
          in: query
          required: false
          description: Weighting method for the distribution, by ein or npi.
          schema:
            type: string
            enum:
              - ein
              - npi
          example: ein
      responses:
        '200':
          description: Percentile rate distribution for the requested code.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/DistributionResponse'
        '401':
          description: Missing or invalid API key.
        '404':
          description: No distribution found for the requested code/filters.
        '429':
          description: Rate limit exceeded.
components:
  securitySchemes:
    ApiKeyAuth:
      type: http
      scheme: bearer
      description: >-
        Serif Health API key passed as a Bearer token in the Authorization
        header (Authorization: Bearer <API_KEY>). API keys are issued by Serif
        Health; contact hello@serifhealth.com for access.
  schemas:
    RatesResponse:
      type: object
      properties:
        code:
          type: string
          description: The procedure code that was queried.
          example: '27445'
        count:
          type: integer
          description: Total number of matching rate records.
          example: 3178
        rates:
          type: array
          items:
            $ref: '#/components/schemas/RateEntry'
    RateEntry:
      type: object
      properties:
        payer:
          type: string
          description: Payer name.
          example: Cigna
        rate:
          type: number
          description: Negotiated rate amount in USD.
          example: 1621
        npi_count:
          type: integer
          description: Number of distinct NPIs contributing to this rate.
          example: 3509
        ein_count:
          type: integer
          description: Number of distinct EINs contributing to this rate.
          example: 2
    DistributionResponse:
      type: object
      properties:
        code:
          type: string
          description: The procedure code that was queried.
          example: '90837'
        npi_count:
          type: integer
          description: Number of distinct NPIs in the distribution.
          example: 1128940
        ein_count:
          type: integer
          description: Number of distinct EINs in the distribution.
          example: 270301
        weighting:
          type: string
          description: Weighting method applied to the distribution.
          example: ein
        distribution:
          $ref: '#/components/schemas/Percentiles'
    Percentiles:
      type: object
      description: Negotiated-rate percentiles in USD.
      properties:
        5th:
          type: number
          example: 92.04
        10th:
          type: number
          example: 92.04
        25th:
          type: number
          example: 103.06
        50th:
          type: number
          example: 126.69
        75th:
          type: number
          example: 133.86
        90th:
          type: number
          example: 162.07
        95th:
          type: number
          example: 179.27