FAIR Health is fully operational and employees are working from home. We do not expect any change to service levels. But if you call our consumer support line (855-566-5871) and do not get a live representative, please leave a message or email firstname.lastname@example.org. One of our representatives will get back to you shortly.
Short articles that explain what you need to know: from bills to your rights
Short articles that explain what you need to know: from bills to your rightsRead more »
Websites that can make your busy health life a little easier
Websites that can make your busy health life a little easierRead more »
How to distinguish the best doctors and hospitals
How to distinguish the best doctors and hospitalsRead more »
If your insurer won't pay for a healthcare service, you can “appeal”
How to review your medical bill
Dental Coverage for Children
FAIR Health's estimates are based on our collection of
31 BILLION healthcare claims for 10,000+ services in all areas of the U.S.
FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. 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 a billion healthcare bills, which are added to FAIR Health's database of more than 31 billion claims. We use information from those claims 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.Back to Top
About Our Data
Our cost estimates are based on claims for medical and dental services paid for by private insurance plans, including the country's largest insurers. Our database includes more than 31 billion private health care claims and 20 billion Medicare claims for 10,000 services in all areas of the United States, dating back to 2002. We receive about 1.7 billion new records each year. These claims represent a large portion of the population—approximately 150 million patients from all 50 states, the District of Columbia, Puerto Rico and the US Virgin Islands. FAIR Health uses this powerful data to create a reliable picture of healthcare costs around the country, and locally.
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.
In addition to creating tools for consumers, we share information with doctors, hospitals, health plans, employers, researchers, policy makers and others to help them make informed decisions related to healthcare and its costs.
A testament to the fairness and reliability of our data, New York, Connecticut, and many other states have adopted FAIR Health's cost information as the guidepost in laws protecting consumers, and for many other purposes.Back to Top
Awards and Recognition
FAIR Health strives to make sure that our website, mobile app and other resources help consumers like you find the information you need.
We are proud of the recognition that our consumer site has received. Consumer rights groups and the healthcare industry have given a number of awards to our easy-to-use website, mobile app and other resources that help consumers find useful and reliable information. The awards include:
2019 eHealthcare Leadership Awards
- Mark Gothberg eHealthcare Organizational Commitment Award
- Best Overall Internet Site (FAIR Health Consumer and FAIR Health Consumidor)
- Best Site Design (FAIR Health Consumidor)
- Best Mobile Website (FAIR Health Consumer and FAIR Health Consumidor)
- eHealthcare Leadership Awards from 2012 to 2018 (2019 is the eigth year in a row FAIR Health received this honor)
- 2016 Employee Benefit News Dig|Benefits Technology Innovator Award
- Kiplinger's Personal Finance 2016 Best List for Best Health Care Cost Estimator
- One of AppPicker's best healthcare apps of 2014
- Cited in URAC's 2013 Best Practices in Health Care Consumer Engagement and Protection
- Included in the Agency for Healthcare Research and Quality (AHRQ), US Department of HHS 2014 QualityTool list on AHRQ Health Care Innovations Exchange
- Featured and honored at the 2012 White House Summit on Smart Disclosure as an Innovator in Consumer Transparency
Here you can learn more about our data, how we estimate healthcare costs in a geographic area near you, and how we decide what to include on our website. We have consulted with leaders in the healthcare field to make sure that our methodologies follow best practices and our data and tools are the best that they can be.
Getting our data. We collect healthcare claims data from health plans and plan administrators. This tells us how much doctors are charging, and how much insurers are paying, for people's care. We test the data, to make sure that the data are reliable.
Organizing data by geozip. We organize the claims data we receive by geozip—a geographic area, usually based on the first three numbers of a zip code. Grouping the charges by geozip helps make sure that the costs represent what providers actually charge in a specific area.
Cost 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 (or “allowed”) rates. The “allowed amount” 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 within those categories, and the results are organized into percentiles for each Geozip. For example, the 80th percentile “allowed amount” for a certain service, means that we estimate 80 percent of payors paid that amount or less for the service. Dental insurance usually works a little differently – the average allowed amounts for dental services estimate the most your insurer would consider paying for your dental care.
Out-of-network costs for a hospital stay for a certain type of treatment in a certain location. The hospital stay cost estimate gives a total for many types of costs, and also breaks them down by type.
Provider-specific charges. 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, and 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.
We identified providers who performed a common service at least the average number of times compared to other providers in your Geozip. From that group, we randomly ordered providers and practices to include on this website. We looked at the claims in our database for those selected providers to identify the range of prices charged for common services, and the most common price that the provider charged for those services, over the course of one year. If there are two equally common prices for a provider, we use the most recent.
Provider-specific charges are not included for all providers and practices in your area. Your provider may not be listed on this website for a number of reasons, including:
- Your provider did not submit claims to any of the contributors to our database (remember, our data come from health plan claims);
- Your provider performed the service fewer times than the average provider in your Geozip;
- The service may not be covered by your health plan, and so your provider does not submit claims to your plan for it;
- Your provider asked not to be listed on this site;
- Your provider's practice does not accept insurance; or
- Your provider's specialty is not one of the common specialties included on our website at this time.
FAIR Health features provider-specific information for 100 procedures that are commonly performed in New York State by physicians, physical therapists, chiropractors, acupuncturists and other providers. We chose these 100 because they were the procedures that were most common in the FAIR Health database; the procedures that are most commonly done in an out-of-network setting; and the procedures that consumers search for the most. We will be adding more procedures in the future.
Quality metrics for individual providers and practices. Our goal is to share information about provider characteristics that will be meaningful to consumers. We asked consumers through focus groups and surveys what type of information they would like to know when choosing a healthcare provider. We then selected information about individual providers that consumers said would be useful, collected from the Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) file and the CMS Provider File, and included it on this website. Information about quality metrics is described in the Quality section.
FH® Total Treatment Cost. Treating complex conditions like type 2 diabetes can involve a lot of different services, supplies, tests and medications. This website provides estimates of the typical overall cost you can expect to pay for all components of caring for certain chronic conditions (like asthma) and event-based procedures (like knee replacement).
The FH Total Treatment Cost estimates include all of the costs for your medical care from the time you get sick or injured until you are better, or when your treatment is over. For chronic conditions, estimates include the typical services for the condition over the course of one year. To create each estimate, we first identify the most commonly performed services associated with each condition or procedure. Then we estimate the cost for each of the services associated with the condition or procedure, and multiply that amount by the number of times patients usually receive each service. We combine all the estimated charges for the number and type of services in a typical treatment cost to give you an estimate.
Decision Aids for Palliative Care. With support from The New York Community Trust, we offer three shared decision-making tools to support the conversation between clinicians and patients (and/or their caregivers). The decision aids offer clinical information and cost information related to:
- Kidney dialysis for patients with kidney failure (whether to continue or stop);
- Nutrition options when swallowing is difficult; and
- Breathing machine (whether to continue or stop).
Hospital Information for New York State:
This website offers information about some hospitals in four locations in New York State (Albany, Buffalo, Syracuse and Westchester):
- Hospital-specific charges. FAIR Health reports what hospitals typically charge for 20 commonly performed outpatient procedures. FAIR Health chose these procedures by identifying those services that appeared most frequently in our database, were most commonly provided out of network and/or were most searched for by consumers.
- Hospital-specific quality metrics. FAIR Health also offers information on quality measures that can help you decide which hospital is best for you and your family. These measures are described in detail in the Quality section of this website.
What is FAIR Health?
FAIR Health is a national, independent not-for-profit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. FAIR Health also uses its database to power a free consumer website available in English and Spanish and an English/Spanish mobile app, which enable consumers to estimate and plan their healthcare expenditures and offer a rich educational platform on health insurance. For more information on FAIR Health, visit fairhealth.org.Back to Top
How was FAIR Health created?
In January 2009, then-New York Attorney General Andrew Cuomo announced the settlement of an investigation into the method used by certain health insurers to determine reimbursements for patients who received care from out-of-network providers. The settlement agreement reached with 12 health insurers focused on bringing fairness and transparency to the out-of-network reimbursement system by creating a non-industry, independent repository of claims data that would be overseen by a not-for-profit organization. FAIR Health was formed to establish that database and oversee the ongoing contribution of claims data to it.Back to Top
What does the FAIR Health database include?
FAIR Health oversees the nation's largest collection of healthcare claims data, which includes a repository of over 31 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million 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.
What is the YouCanPlanForThis.org website?
Funded by the New York State Health Foundation, this website enables New York State residents to identify and compare providers in their geographic locations. In September 2017, FAIR Health launched this consumer website which 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.
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.Back to Top
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 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.Back to Top
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.
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 and 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.Back to Top
Does FAIR Health endorse any of the healthcare providers or practitioners who are listed on this website?
FAIR Health is an independent, not-for-profit organization and does not endorse any of the healthcare providers or practitioners who are listed on this website.Back to Top
Copyright 2020, 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 31 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.Back to Top
Why was FAIR Health created?
FAIR Health was created in 2009, after the New York State Office of the Attorney General investigated potential conflicts of interest in the methods that health insurers were using to set reimbursement for patients who received care from out-of-network providers (doctors or other health providers that do not contract with the patient's health insurer). The case was settled with health insurers that do business in New York State. The settlement agreements focused on bringing fairness and transparency to the out-of-network reimbursement system.
FAIR Health was created as part of this settlement and charged with establishing and overseeing an independent database with cost data for billions of billed medical and dental services and procedures. We use that database to power this free website.Back to Top
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. This data tells 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 three 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 within 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 and event-based procedures like knee replacement, both in-network and out-of-network care.
- 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.
- 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:
- Kidney dialysis for patients with kidney failure (whether to continue or stop);
- Nutrition options when swallowing is difficult; and
- Breathing machine (whether to continue or stop).
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, multi-step 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.Back to Top
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.Back to Top
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.Back to Top
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
- 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.
- 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
- 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
The cost lookup tools and educational content on this site are also available in Spanish (fairhealthconsumidor.org). You can get our cost information and educational resources on your phone by downloading our FH® Cost Lookup mobile app in English and Spanish 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 who are covered by Medicare, Medicaid or other government programs?
No. The cost estimates generally apply only to those who are covered by private insurance or who are uninsured. These cost estimates do not apply to those who are 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 can also 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.Back to Top
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 at email@example.com.
For information on licensing FAIR Health data for healthcare professionals and commercial businesses, contact firstname.lastname@example.org.Back to Top
Licensing/Linking to this Website
I would like to link to your website from my organization's website. How can I learn more?
FAIR Health welcomes organizations to link to our website and download materials for consumer use.
FAIR Health is a not-for-profit organization that relies in part on license fees to support its work. When consumers use our site, we incur fees from third parties. For that reason, links to fairhealthconsumer.org for commercial purposes require a license agreement and nominal fees. Commercial purposes include, but are not limited to, links established by providers or third-party payors in connection with participation on state or federal health benefit exchanges.
FAIR Health also licenses educational material, videos and cost lookup tools for use on organization websites and for other uses. Please contact email@example.com to learn more.Back to Top
Stay in Touch
How can I get FAIR Health updates?
How can I give feedback on this website?Back to Top
How did you select the hospitals listed on the website?
We selected hospitals that are located in Albany, Buffalo, Syracuse or Westchester and that have 50 beds or more.
How did you select the hospital-based outpatient procedures for which you offer pricing?
We selected the outpatient procedures based on how often they appeared in our database, how often they are provided out of network and what consumers search for the most. Pricing for inpatient services is also available.
From where did you get the prices for the hospital outpatient procedures?
FAIR Health drew the price information for the selected outpatient hospital procedures from its comprehensive, proprietary claims database.
How did you select the quality metrics for each of the hospitals?
FAIR Health met with stakeholders representing consumers, hospitals and plans before selecting the quality measures featured on this website. We selected measures from the New York State Department of Health's NYS Health Profiles website and the Centers for Medicare & Medicaid Services' Hospital Compare website.Back to Top