Ca Medical Exclusions vs Loa Healthcare Pricing

Ca Medical Exclusions tools

No tool names declared yet. Check the project README from the listing page.

Loa Healthcare Pricing tools 11

• search_cpt_codesCanonical code-lookup tool for this server. Search Loa's CPT/HCPCS index using exact codes, clinical terms, or consumer phrases. Use this first when the user does not already know the CPT code, before calling pricing tools.
• search_providersSearch public CMS NPI Registry data for clinicians and healthcare organizations by specialty, name, or location. Use returned provenance to understand the registry source and scope. Use this for provider lookup, not pricing.
• get_pricing_estimateQuick cash-price ballpark for one or more CPT codes, using the median cash price across hospitals in the state (from zip_code) or nationally. priceRange is the typical range (25th to 75th percentile of hospitals). Codes without enough data return insufficient_data and are listed in missingCodes; the total is null unless every code has data. Never fill gaps with your own estimate. For insurer rates or hospital-specific prices, use get_market_pricing or get_hospital_pricing.
• get_market_pricingPreferred benchmark pricing tool. Returns hospital-level market statistics for CPT codes from Loa's published hospital price-transparency data: cash/self-pay prices, list prices (gross charges before discounts), overall insurer-negotiated rates, and rates for the most common insurers. Each hospital counts once. Lead with the median and the p25-p75 range rather than min or max. Figures are statewide or national, never local to a ZIP code. When status is insufficient_data, say Loa doesn't have enough data instead of estimating, and always relay the limitations. Negotiated rates are not out-of-pocket costs.
• search_hospitalsSearch Loa's hospital directory by name or location and return hospital IDs plus address details. Use the returned hospital_ids with get_hospital_pricing to fetch source-labeled Published MRF and reviewed overlay prices.
• get_hospital_pricingHospital-specific pricing tool for source-labeled Loa runtime data. Returns source-labeled Published MRF prices and Loa Verified Provider Price overlays for CPT codes. cash_price is the cash/self-pay price, list_price is the gross charge before discounts (most patients pay less), and insurance_prices are payer-negotiated rates for the named plan, not out-of-pocket costs. Any of these can be null when the hospital did not publish that price. Use this when comparing named hospitals or checking a quoted hospital price against available source rows.
• search_entitiesSearch Loa runtime hospital and provider entity pages by name or state. Use this before get_entity_prices when the user names a hospital or provider but does not know the exact Loa slug.
• get_entity_pricesReturn source-labeled prices for a Loa hospital or provider entity slug using the shared resolver. Use search_entities first if the slug is unknown. Results include provenance and explicit unavailable rows for requested CPT codes with no current price.
• get_entity_profileReturn one Loa hospital or provider entity profile by exact slug or entity_pages.id. Includes profile-field provenance so agents can distinguish source-file fields from Loa-reviewed overrides.
• explain_price_sourcesExplain the source labels, provenance, confidence, and caveats behind Loa prices for one hospital or provider entity. Use this when an agent needs to tell a user why prices are MRF-published, Loa-reviewed, estimated, or unavailable.
• submit_entity_update_requestSubmit a profile, listing, or price correction for Loa review without requiring a provider portal. This is the only mutating provider/entity tool. It requires OAuth, captures submitter and source evidence, records linked-provider status when available, and never changes public data until Loa approves the request.