Consumers
Estimate your healthcare expenses

What is FAIR Health?

How was FAIR Health created?

In January 2009, the New York State Attorney General announced the settlement of an investigation into perceived conflicts of interest involving the adjudication of claims. The Office of the Attorney General reached settlement agreements with health insurance companies that do business in New York State, and FAIR Health was established as part of this settlement. In October 2009, FAIR Health was formed as an independent organization to bring transparency, integrity, reliability and accessibility to healthcare costs and insurance information for all healthcare stakeholders. Our mandate was to provide an independent database of claims information contributed by payors nationwide, a free website to educate consumers about the cost of care in their geographic areas and insurance reimbursement, and data for research that could help to formulate or evaluate policy and support academic studies.

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What does the FAIR Health database include?

FAIR Health oversees the nation's largest collection of private healthcare claims data, which includes a repository of over 48 billion privately billed medical and dental procedures, and separate data representing the experience of individuals enrolled in Medicare. Certified by CMS as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts.

To keep our cost information current, we ask our contributors to send us new records regularly throughout the year, and we update the cost data on this website twice each year.

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What is the YouCanPlanForThis.org website?

Funded by the New York State Health Foundation, this website houses educational resources and decision aids for various conditions, information regarding costs for medical and specialty care and elective procedures and links to external resources that assist consumers with their health and health insurance. With these resources and cache of information, New York State residents can identify and compare providers and the services they provide in their geographic locations, allowing them to make informed decisions about their healthcare.

In September 2017, FAIR Health launched this consumer website that offers:

• De-identified, aggregated allowed and billed-charge data by geozip;
• Provider-specific charges, practice attributes and quality information (e.g., participation in e-health records, education) based on 100 procedures commonly performed in the state; and
• FH^® Total Treatment Cost for certain chronic conditions (like asthma) and event-based procedures (like knee replacement).
• This website also features quality and cost information for certain commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany and Buffalo, New York.

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How did FAIR Health select the procedures for which to offer provider-specific information?

FAIR Health selected procedures that were the most common in the FAIR Health database; that are most commonly performed in an out-of-network setting; and that consumers search for the most.

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How were healthcare providers selected to be listed on this website?

This website includes those providers (physicians, physical therapists, chiropractors, acupuncturists and others) in New York State who performed one of the 100 common procedures, at least the median number of times compared to other providers in a geozip. We list those providers and practices in random order on this website. Based on the claims in our database, we identify each of those providers' range of prices charged and most common price charged for the 100 common procedures, over the course of one year.

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Why am I not included on the website as a listed provider?

Provider-specific charges are not included for all providers and practices. You may not be listed on this website for a number of reasons, including:

• You did not submit claims to any of the contributors to our database (our data come from health plan claims);
• You performed the procedure fewer times than the median provider in your geozip;
• You asked not to be listed on this site;
• Your practice does not accept insurance; or
• Your specialty is not one of the common specialties included on our website at this time.

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How did FAIR Health decide which types of information to share about providers? Where does this information come from?

We learned from consumers through focus groups and surveys what type of information they would like to know when choosing a healthcare provider. We then looked at the FAIR Health database, which includes provider-level information and pricing, the CMS National Plan & Provider Enumeration System (NPPES) file and the CMS Provider File, and selected information about individual providers that consumers said would be useful to include on this website.

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Does FAIR Health endorse any of the healthcare providers or practitioners listed on this website?

FAIR Health is an independent, not-for-profit organization and does not endorse any of the healthcare providers or practitioners listed on this website.

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Does FAIR Health offer products for healthcare providers?

Yes, FAIR Health provides additional resources for physicians and to other providers on FAIR Health Provider (www.fairhealthprovider.org). FAIR Health Provider offers the following features and services:

• FH^® Fee Estimator
• Free educational content on shared decision-making and related tools and resources

To learn more, email info@fairhealth.org or call 855-301-FAIR (855-301-3247).

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Copyright 2024, FAIR Health, Inc. FAIR Health has not evaluated and does not endorse any healthcare providers or practitioners listed on this website. Learn more.

What is FAIR Health?

FAIR Health's mission is to help you understand your healthcare costs and health coverage. We are an independent, national, nonprofit organization known for providing fair and neutral information to all those we serve, including consumers like you.

We are able to provide reliable information about healthcare costs because each year health insurers around the country send us over 2 billion healthcare claim records, which are added to FAIR Health's database of more than 48 billion claim records. We use information from those claim records to estimate what providers charge, and what insurers pay, for providing healthcare to patients all across the country. We make this information available to consumers, researchers, businesses and many other users. Learn more by visiting our company website at fairhealth.org.

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Why was FAIR Health created?

FAIR Health was created in October 2009, after the New York State Office of the Attorney General investigated perceived conflicts of interest involving the adjudication of claims. The Office of the Attorney General reached settlement agreements with health insurance companies that do business in New York State, and FAIR Health was established as part of this settlement. In October 2009, FAIR Health was formed as an independent organization to bring transparency, integrity, reliability and accessibility to healthcare costs and insurance information for all healthcare stakeholders. Our mandate was to provide an independent database of claims information contributed by payors nationwide, a free website to educate consumers about the cost of care in their geographic areas and insurance reimbursement, and data for research that could help to formulate or evaluate policy and support academic studies. This is the free website we were charged with creating, powered by our database of billions of claims.

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Where does FAIR Health get its cost data?

We collect healthcare claims data from health plans and plan administrators for all 50 states; Washington, DC; Puerto Rico; and the US Virgin Islands. These data tell us how much doctors are charging, and how much insurers are paying, for people's care. We organize the claims data we receive by geozip—a geographic area, usually based on the first three numbers of a zip code.

From these data, we provide different kinds of cost information:

• Charge estimates. Different providers are generally free to charge different prices for the same service. We organize these charges into percentiles, from lowest to highest. For example, if a provider's price is in the 80th percentile for a certain service, that means 80 percent of the fees billed by other providers for the same service were that amount or lower.
• In-network rates. The in-network rate is FAIR Health's estimate of what an insurer may pay your in-network provider for a particular service. To estimate this, FAIR Health determines the ratio between what providers charge and how much insurers pay for certain categories of medical services. We apply those ratios to the charges in our database for services in those categories. The results are organized into percentiles for each geozip. For example, the 80th percentile in-network rate for a certain service means that we estimate 80 percent of payors paid that amount or less for the service.
• Average allowed amounts for dental services. The most your insurer would consider for your dental care.
• Out-of-network costs for a hospital stay for a certain procedure in a certain location. The hospital stay cost estimate gives a total for many types of costs, and also breaks them down by type.
• Costs and other information related to FH^® Total Treatment Cost. Our cost estimator can show you the overall cost you can expect to pay for the many different services, supplies, tests and medications involved in caring for chronic conditions like type 1 or 2 diabetes, acute conditions like pregnancy and event-based procedures like knee replacement. Both in-network and out-of-network costs are shown.
• Cost estimates for medical equipment, supplies and accessories. In addition to specific services and elective procedures, our FH® Medical Cost Lookup tool provides typical costs for medical equipment, supplies and accessories to help manage chronic conditions. These include speech and hearing supplies and wheelchairs and related accessories, among others.
• Provider-specific charges. In New York State, FAIR Health reports what some specific providers in your area typically charge for 100 commonly performed procedures. We looked at physicians, physical therapists, chiropractors, acupuncturists and other providers in New York State. We identified those services that appeared most frequently in our database; were most commonly provided out of network; and/or were most searched for by consumers. We excluded some preventive screening procedures because health plans typically cover them for free. Additional services will be added in the future.
• Costs related to urgent care. Provides typical costs for the most commonly billed urgent care services and procedures in your area. These are the standard costs in an urgent care center if you’re uninsured or going out of network.
• Costs for shoppable services. We offer prices for more than 300 services, exams and procedures, including imaging, heart, laboratory and lung tests; eye, ear and bone marrow surgeries; endoscopies and colonoscopies; and therapy and rehabilitation services. Using our Shoppable Services tool, you can learn the average price for various services in your area and surrounding areas.
• Shared decision making tools for three palliative care scenarios. Supported by a grant from The New York Community Trust, we offer decision aids for three palliative care scenarios that help patients and caregivers have meaningful conversations with their healthcare providers regarding:
  • Dialysis for People Who Are Seriously Ill;
  • Nutrition Options for People Who Are Seriously Ill; and
  • Ventilator for People Who Are Seriously Ill.
• Educational information on diverse topics pertaining to navigating the healthcare system. Provided as an educational resource, FH Insurance Basics enables consumers to learn more about health insurance with topics that explain how to understand different plan options and select a plan that is right for them, terms and concepts relevant to their health plans, medical bills, and to evaluate differences among settings for care and more.
• A Glossary and Resources section that houses links to external resources to organizations that can further assist consumers with their healthcare and a glossary of commonly used medical, dental and health insurance terms.
• A healthcare quality toolkit that helps consumers understand how to compare healthcare providers based on different metrics.

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How does FAIR Health make sure that its data are reliable?

FAIR Health's in-house experts in statistics, economics and technology carefully follow a rigorous, multistep process to check that the data are valid and reliable. Only valid data are added to the FAIR Health database. Learn more about our process here.

The medical and dental charge estimates on this website are based on the FAIR Health database and are kept current through updates every year.

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Does FAIR Health set “usual, customary and reasonable” (UCR) rates for insurers?

No. FAIR Health offers benchmark charge data that some insurers may use to help inform their rates for out-of-network reimbursement. FAIR Health does not set UCR rates or out-of-network reimbursement rates for insurers. Although some insurers may choose to use our data (usually combined with other information) to determine UCR, these decisions are made solely by insurers based on their internal policies.

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Who serves on the FAIR Health Board of Directors?

The FAIR Health Board of Directors comprises recognized leaders in the fields of medicine, healthcare policy, law, consumer advocacy, technology, education, medical research and business. They serve without compensation and adhere to rigorous conflict-of-interest policies.

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Consumer Website Tools Available through This Website

What will I find on this website?

This website is here to help both insured and uninsured people make decisions about healthcare. The cost lookup tool shows you what medical and dental care cost in your area. At this time, we have cost estimates for:

• Thousands of medical and dental services (professional fees);
• Medical supplies (e.g., diabetes supplies, walkers, canes, vision supplies, hearing aids);
• Anesthesia services;
• Ambulance rides; and
• Telehealth services;
• Urgent care services;
• Shoppable services; and
• Services done in a facility (e.g., hospital or ambulatory surgery center).

The educational resources help you choose a health plan, pick a doctor, understand your healthcare bills, negotiate prices with your provider, appeal your plan's payment, plan your costs in advance and more.

This website allows you to search for:

• How much you might pay for a medical or dental service if you're uninsured.
• Out-of-network costs that you may pay if you go to doctors who are not in your health plan's network.
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• In-network costs. You can estimate how much you may have to pay for doctors in your health plan's network if you haven't met your deductible.
• The average allowed amount for dental services
• Costs and other information related to FH^® Total Treatment Cost. Our cost estimator can show you the overall cost you can expect to pay for the many different services, supplies, tests and medications involved in caring for chronic conditions like type 1 or 2 diabetes, acute conditions like pregnancy and event-based procedures like knee replacement, both in-network and out-of-network care.
• The basics of health coverage, from the differences among plan types to how a deductible works and more. Health insurance is very complicated, but our educational articles, videos and glossary terms can help you better understand how health insurance works.
• Where to get help. We provide links to health-related organizations that can help you.
• Cost estimates for hospital stays.
• Shared decision making decision aids for palliative care.
• Costs by specific venue of care, including telehealth, urgent care, hospital and ambulatory surgery center.
• Costs for elective procedures (i.e., “shoppable services).
• Costs for various medical supplies, accessories and equipment.

The cost lookup tools and educational content on this site are also available in Spanish (fairhealthconsumidor.org). In addition, a mobile app, FH^® Consumer Classroom, offers the website’s educational content—FH Insurance Basics, resource links, glossary, healthcare quality toolkit—along with interactive puzzles in a concise, user-friendly format. The app, which links to FAIR Health Consumer’s cost estimators and shared decision-making decision aids, is available from the App Store and Google Play

We've also created new features and educational content especially for New Yorkers. This website offers a new healthcare planning tool developed by FAIR Health for New York State residents, with support from the not-for-profit New York State Health Foundation. It features information on local physicians and other healthcare providers who can provide some of the healthcare services or procedures found on this website. You also can compare providers by price and certain practice features, such as the number of years they've been in practice, their location, the hospitals they work at and their training. In the future, the site will also feature quality and cost information for certain commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany and Buffalo, New York.

Who can use this website?

Insured and uninsured consumers—patients and their caregivers—can use this website to learn about health insurance and estimate their costs of care. It may be of particular use to people managing a deductible, wanting to learn more about health insurance or looking for access to one of the FH Total Treatment Cost conditions or procedures. Before you receive care, you can use the site to plan your costs or negotiate fees. After you receive care, you can use it to negotiate payment or support appeals.

Do the medical cost estimates apply to people covered by Medicare, Medicaid or other government programs?

No. The cost estimates generally apply only to those covered by private insurance or uninsured. These cost estimates do not apply to those covered by government programs such as Medicare, Medicaid or Tricare.

However, these cost estimates may be useful to you if you have coverage under a government program, but you are getting care that is not covered by that program. For example, Medicare does not cover most dental services. If you have Medicare and you need to see a dentist, you can find out how much you may pay. The information on the site also can help you evaluate a Medicare Advantage plan that requires you to pay more for services outside of the plan's network.

Note: Some private insurers (i.e., non-government) use Medicare rates to set out-of-network reimbursement, which means that the insurer will pay some percentage or multiple of what Medicare would have paid for the services. This is not the same as being covered by Medicare. If your insurer refers to Medicare rates in this way, you can use this website to estimate your medical out-of-pocket cost: on the cost results page, selecting the appropriate option under the “Estimated Reimbursement” dropdown section under “Adjust Charge.”

I searched for a cost estimate and got "N/A." What does it mean?

If you see N/A (Not Available) after searching for a cost estimate, this means that we cannot provide at this time a cost estimate for the procedure code in the geographic area you searched.

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Search Limits

Why does the website limit the number of searches I can conduct?

This website is for consumer use. It is expected that in most cases, consumers will be able to meet their needs before reaching the search limits. If you are a consumer and feel you have been inappropriately blocked, please email us consumer@fairhealth.org.

For information on licensing FAIR Health data for healthcare professionals and commercial businesses, contact info@fairhealth.org.

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Licensing/Linking to this Website

I would like to link to your website from my organization's website. How can I learn more?