Medical Claims Pricing That Works.
Pricing tools made for how the real world works. Accurate, easy, reliable.
From Medicare fee schedules to full contract management — Kestrel delivers accurate, reliable claims pricing, implemented quickly by your team to fit your needs.
Claims Pricers That Work For Your Contracts
Healthcare contracts are negotiated by humans, who have a well-documented penchant for "getting creative". Claims pricers are mostly built by engineers that don't have to maintain a billion fee schedules. Kestrel fills the gap with powerful, flexible tools that are easy to use, understand, and implement.
The result? Your team moves faster and more confidently. You don't have to manage dozens of fee schedules across hundreds of geographical regions. Changes in the environment - regulations, standards, and tools - are easy to absorb. Your configuration management workload drops. Accuracy and timeliness improve. Your provider community starts calling to ask what the hell you're doing right and why your competitors can't get there.
You don't need a massive, expensive vendor implementation team, a six-month project plan, or a sacrificial altar to price claims correctly. Kestrel puts you in control with tools that are easy, familiar, and accurate.
"Contracts aren't written for claims pricers. But claims pricers aren't built for contracts - that's the problem."
Introducing Kestrel
A claims pricing engine built around one simple idea: there's a better, easier way to do this.
Whether you need fast, reliable Medicare fee schedule lookups via API or a full contract management platform that handles everything from modifier adjustments to per diem rates to custom conversion factors — Kestrel meets you where you are. No expensive implementation project. No opinionated middleware telling you how your contracts should work. Just accurate pricing, delivered the way your team actually operates.
Integrate in hours, not months. RESTful, documented. Built for developers who have better things to do.
Your rates, your rules. Kestrel prices claims the way your contracts actually read.
From a single developer kicking the tires to a health plan processing millions of claims — add complexity only when you need it.
Who Uses Kestrel
Whether you're building a health tech product or running a payment integrity team, Kestrel fits where you are.
Fast, reliable pricing infrastructure — so you can focus on your product
You're building something ambitious and the last thing you need is to also build a claims pricing engine from scratch. Not to mention maintaining fee schedules every quarter. Gross. Kestrel's API gives you accurate Medicare fee schedule lookups and fee schedule pricing on day one — so you can ship faster, impress your first customers, and add complexity only when you need it.
Catch what your current system is missing
You're processing claims every day and trusting that the numbers are right, only to get burned time after time. Kestrel gives your team an independent reference point — a fast, accurate way to validate pricing, catch discrepancies, and defend your numbers when a client comes asking questions. You can even integrate it into your least favorite Core Administrative Processing System (CAPS) if you're tired of adjusting claims all the time.
Find out what your rented network is actually costing you
Your TPA handles the claims. But do you know if they're being priced correctly against your plan's contracts? Kestrel gives you a plain-language answer — and the receipts to back it up when it's time to have that conversation with your broker.
Enterprise-grade pricing without an enterprise implementation project
Small and mid-size plans shouldn't have to choose between accuracy and affordability. Kestrel gives you the contract management capabilities that your larger competitors only wish they had — at a price point that doesn't require a board approval. And bonus: we maintain the fee schedules for you. So you don't need to also ask for more staff to run the thing.
Simple to Start. Powerful When You Need It.
Simple enough to integrate in an afternoon. Powerful enough to run your entire claims operation.
Grab your API key and make your first call in minutes. Kestrel's REST API is documented, versioned, and built for developers who don't have time to read a 200-page integration guide. If you can call an API, you can price a claim.
Start with Medicare physician fee schedules out of the box and free. Layer on DME, ASP, and Clinical Lab Fee Schedules when you're ready. Go for full Medicare-based pricing with our Max Pro plan - including multi- procedure reductions, global surgery days, and anesthesia. All implemented at your own pace.
Submit a claim line. Get back an accurate price with detailed provenance and pricing errors in plain English. It's not more complicated than that — and that's exactly the point.
{ "hcpcs_code": "99213", "modifier": "25", "zip_code": "90210", "facility": false, "as_of": "2026-02-14" }
// Response
{ "success": true, "message": "PFS price calculated successfully", "data": { "payment_amount": "98.19", "inputs": { "hcpcs_code": "99213", "modifier": "", "modifier_used": null, "zip_code": "90210", "mac": "01182", "locality": "18", "facility": false, "qualifying_payment": false, "as_of": "2025-06-01" }, "rvus": { "work_rvu": "1.3", "pe_rvu": "1.35", "mp_rvu": "0.1", "status_code": "A", "effective_date": "2025-01-01", "termination_date": "2025-12-31" }, "gpcis": { "gpci_work": "1.042", "gpci_pe": "1.194", "gpci_mp": "0.69", "effective_date": "2025-01-01", "termination_date": "2025-12-31" }, "conversion_factor": "32.3465", "mac": "01182", "locality": "18", "facility": false, "qualifying_payment": false, "modifier_used": null, "effective_date": "2025-01-01", "termination_date": "2025-12-31" }, "meta": null, "errors": []] } { "allowed_amount": 124.38, "fee_schedule": "Medicare PFS 2026", "modifier_applied": "25", "pricing_basis": "110% Medicare", "locality": "TX-San Antonio" }
Simple, Transparent Pricing
Start free. Scale when you're ready. No implementation fees, no surprise invoices, no contracts — until you want one.
| FreebieFree | Mini Pro$99/mo | Pro$299/mo | Max Pro$1,099/mo | Enterprise Enterprise Custom Pricing | |
|---|---|---|---|---|---|
| Fee Schedules | Medicare PFS | Medicare PFS | PFS, ASP, Labs | PFS, ASP, Labs, DME, OTP, Ambulance Vaccine Anesthesia |
Full + Custom |
| Requests / Month | 2,000 | 25,000 | 100,000 | 1,000,000 | 50,000 claims |
| Batch Processing | — | — | — | Up to 250 lines | Unlimited |
| Contract Management | — | — | — | — | ✓ |
| Custom Contracts | — | — | — | — | Unlimited |
| Modifier Adjustments | — | — | — | ✓ | ✓ |
| Multi-Procedure Discounts (MPPR/MPD) | — | — | — | ✓ | ✓ |
| Global Surgery Day Tiers | — | — | — | ✓ | ✓ |
| Mid-Level Provider Adjustments | — | — | — | ✓ | ✓ |
| Flat Rates, Tiered Rates, Per Diems | — | — | — | — | ✓ |
| Percent of Billed/Default Rates | — | — | — | — | ✓ |
| Custom Anesthesia Calculations | — | — | — | — | ✓ |
| API Access | ✓ | ✓ | ✓ | ✓ | ✓ |
| Multi-User Support | — | — | — | — | ✓ |
| Join Waitlist | Join Waitlist | Join Waitlist | Join Waitlist | Book a Demo |
Build & manage in- and out-of-network contracts · Provider specialty restrictions and adjustments · Full claims pricing · Configurable modifier adjustments · Configurable anesthesia calculations · Percent of billed charges · Multi-procedure discounts · Tiered pricing · Flat fee · Per diem · Percent of DRG/APC/OPPS · Custom fee schedules · Medicaid support via custom fee schedules · Default contract terms · CMS fees automatically maintained · Claims data entry support · Up to 3 users included ($25/user/month additional) · Up to 4 hours/month configuration support · Full library of configuration videos, guides, and cookbooks · Report server add-on available
All paid tiers include automatic CMS fee schedule updates, full API documentation, and no long-term commitments.
Be First in Line
Kestrel launches in October 2026. Join the waitlist for early access, launch pricing, and a first look at what's coming.
Let's talk before launch. Early Enterprise customers get priority onboarding, dedicated configuration support, and a say in what we build next.
- Priority onboarding before general availability
- Dedicated configuration support
- Direct input on the product roadmap
- Custom pricing for your volume and use case