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Frequently Asked Questions


About FH Fee Estimator

What is the FH Fee Estimator?

The FH Fee Estimator provides benchmark charge data representing the full non-discounted fees for over 30 medical specialties and dentistry. The data represent the aggregation of professional fees charged for medical or dental procedures in distinct geographic areas, called geozips, which are generally identified by the first three digits of a zip code.

FAIR Health’s self-service FH Fee Estimator website at www.feeestimator.org enables healthcare professionals and consultants to choose specialties and locations, and download the data in minutes. Data are arrayed by percentiles, providing a view of the distribution of charges for each procedure. FH Fee Estimator products also include the mean (average), median (middle/50th percentile) and mode (most common) charges for each procedure code/geozip combination. In addition to charge data, the FH Fee Estimator provides the Medicare fee for each procedure.

Does FH Fee Estimator include facility charge data?

The data represent professional charges only. If you are interested in licensing facility charge data, please call the FAIR Health sales team at (855) 301 - FAIR (3247) or email service@fairhealth.org

Where do the Medicare fees come from?

Medicare fees are taken from the Medicare fee schedule established by the Centers for Medicare and Medicaid Services (CMS). Amounts reflected in the FH Fee Estimator are the fees for the procedure code in the Medicare Geographic Practice Cost Index (GPCI) area that maps most closely to the corresponding FAIR Health geozip. When a FAIR Health geozip overlaps two or more GPCIs, the fee from the GPCI with the highest population is displayed.

How many specialties can be ordered online?

Up to five products, consisting of a medical specialty or dentistry for a geozip, can be ordered online through FH Fee Estimator. If you wish to order more than 5 specialties/locations, please call (855) 301-FAIR (3247) or email service@fairhealth.org

What if I need more than five specialties and/or locations?

If you wish to order more than five products, please call (855) 301-FAIR (3247) or email service@fairhealth.org A member of the FAIR Health team will be pleased to discuss product options that include broader sets of data.

How do I request additional codes to be included in the FH Fee Estimator?

FAIR Health seeks to continually enhance its products. If there are additional codes that you would like to see in an established product, please email service@fairhealth.org or call (855) 301-FAIR (3247).

Is it possible to create a customized product that includes a specific set of codes?

Yes. If you would like to create a “custom cut” of the data that includes certain codes that may cross various specialty products, please email service@fairhealth.org or call (855) 301-FAIR (3247).

Are evaluation and management (E&M) codes included?

Yes, evaluation and management procedure codes are included with each medical specialty.

Why is FH Fee Estimator limited to a single user?

When you order FH Fee Estimator, you are licensing data from FAIR Health and sublicensing the use of procedure codes for the term of the license. Our license agreements with external parties require that we track users of the FH Fee Estimator. If you have questions about the license agreement, please call (855) 301-FAIR (3247).

Is FAIR Health setting prices through its FH Fee Estimator?

FAIR Health does not set or prescribe prices. FH Fee Estimator provides up to eight charge benchmarks for each procedure code/geozip combination, which reflect aggregated claims data that can be used for a variety of purposes. Some practices use FAIR Health data to better understand market conditions and as one of the sources to help inform their development of fee schedules. Practices are advised to seek legal advice if they have questions about their uses of data.

What time period do the data represent?

Benchmarks in FH Fee Estimator products are based on claims with dates of service for a twelve-month period. The actual dates of service vary by product but generally coincide with the twelve-month period ending three to four months prior to when the benchmarks are released by FAIR Health.

How often are the data refreshed in FH Fee Estimator?

FH Fee Estimator data are updated twice a year.Medical benchmarks are updated at the end of June and the end of December; Dental benchmarks are updated at the end of February and the end of August. Please keep in mind:

  • Online users are entitled to one mid-year data refresh;
  • Download users are not entitled to refreshed data; and
  • Download users may upgrade to Online usage for a pro-rated fee and gain access to the refreshed data.

What is the difference between FH Fee Estimator Online and the FH Fee Estimator - Download product?

Both the FH Fee Estimator - Download and FH Fee Estimator Online entitle healthcare professionals and consultants to download data. However, FH Fee Estimator Online offers additional valuable features that enable licensees to:

  • Access data anytime, from anywhere, using any common web browser;
  • Search for data by keyword or procedure code;
  • Select, view, download and print only the data points you need;
  • Choose from simple and advanced views of data formats;
  • Customize your data views;
  • Refresh data mid-year; and
  • Enter practice data into the FH Fee Estimator Workbook to compare fees to market benchmarks, model fee schedules, evaluate contracts and manage other practice financial strategies.

Why should I use FH Fee Estimator?

FH Fee Estimator provides immediate access to benchmark charge data that can help medical and dental practices manage financial and billing strategies. Advantages of FH Fee Estimator include:

  • Data available for all medical and dental codes
    • Actual charge data as reported by healthcare professionals
    • For rarely performed procedures, derived methodologies based on relative values are used to produce benchmarks
  • Immediate, instant downloads - no waiting for books to arrive
  • Multiple benchmarks, including the mean, median (50th percentile) and mode, and Medicare fees are included for each procedure code/geozip combination
  • Transparent - FAIR Health fully explains the methodologies it uses to develop benchmarks
  • Methodologies are reviewed by health policy and economics researchers
  • Based on FAIR Health’s robust database of billions of billed medical and dental procedures

What data are included?

Benchmarks are developed from the non-discounted fees-for-service that healthcare professionals report to insurers through the claims process. Data include:

  • Benchmarks at the 50th - 95th percentiles;
  • Select, view, download and print only the data points you need;
  • Mean (average) charge;
  • Median (middle) charge (equal to the 50th percentile charge);
  • Mode (most frequent) charge; and
  • Medicare fee.

Using FH Fee Estimator data

How can I use the data?

Benchmarks are developed from the non-discounted fees-for-service that healthcare professionals report to insurers through the claims process. Healthcare professionals and consultants use FAIR Health charge data in a variety of ways including to:

  • Evaluate and negotiate network contracts;
  • Inform the development of fee schedules with local market data;
  • Negotiate compensation for participation in exchanges and ACOs;
  • Determine charges for out-of-network services;
  • Develop strategies for bundled payments;
  • Assess expansion into new geographic areas;
  • Estimate insurance reimbursement when considering new equipment purchases; and
  • Analyze the impact of adding a new specialty or business line to the practice.

What is a percentile?

In the FAIR Health database, healthcare practitioners' non-discounted fees-for-service (charges) are arrayed from lowest to highest and organized into percentiles. In statistics, a percentile represents the value below which a certain percent of observations fall.

Why is the amount sometimes the same for multiple percentiles?

It is not uncommon for the same value to be reflected in multiple percentiles. For example, in cases where all reported charges in a given area for a procedure code are the same, the amount of that charge will be reflected in all percentiles.

Why are zeros displayed for certain codes in the benchmark charge percentiles?

FH Fee Estimator displays charge benchmarks based on actual data for each procedure code/geozip combination. If the data for a given procedure code/geozip combination are not sufficient to produce a benchmark, a relative value methodology is used. The relative value methodology takes actual data as a starting point and applies statistical techniques including relative values and conversion factors to derive benchmark charge amounts.

As part of the relative value methodology, procedure codes are grouped together with like codes and data from the procedure code group are used to derive data for each code in the group. In rare instances where the FAIR Health database contains no actual data for any of the codes in the group, the benchmarks displayed for all codes in the group in the geozip are zero. See www.fairhealth.org/FHILibrary#Methodologies for more information about the relative value methodology.

How can I use the FH Workbook feature?

FH Fee Estimator Online includes a useful workbook that enables healthcare professionals to compare their own fees to market data and easily model how changes to fee schedules might impact practice revenues. The FH Workbook is not available with FH Fee Estimator- Download.

Why is my reimbursement different from the FH Fee Estimator data?

FAIR Health does not set usual, customary and reasonable (UCR) charges. However many insurance companies and other payors license FAIR Health data to help them develop their UCR fee schedules. Payors may use different percentiles of FAIR Health data to inform their determination of UCR, or may base out-of-network reimbursement on other criteria such as Medicare fee schedules, negotiated fee schedules or other proprietary formulas. The charges reflected in FH Fee Estimator are benchmarks aggregated from market data based on all billed charges in our database for a specific twelve-month period, procedure code and geographic area.

About FAIR Health data

How large is the FAIR Health Database

Products available through FH Fee Estimator are drawn from the FAIR Health database, which contains over 20 billion billed medical and dental procedures from 2002 to the present. Data are contributed by over 60 payors representing more than 151 million lives covered by private health insurance. The FAIR Health data available through FH Fee Estimator are based on private insurance claims. Medicaid claims are not included in the FAIR Health database.

What information is included in FH Fee Estimator?

The FAIR Health data available through FH Fee Estimator are the full, non-discounted professional fees charged for procedure codes, organized by dentistry and medical specialty.

Who uses FAIR Health data?

FAIR Health makes multiple formats of data available to provide a window into the data to all stakeholders in the healthcare system that include:

  • Commercial payors – insurance carriers, health plans, third-party administrators and self-insured employers;
  • Consumers, through the website at www.fairhealthconsumer.org;
  • Employers, unions, and human resources professionals to educate members and employees;
  • Academic and policy researchers;
  • Government agencies;
  • Hospital systems and their affiliated practices; and
  • Medical and dental practices and practice managers – solo practices, single and multi-specialty groups.

Which payors contribute data to the FAIR Health database?

FAIR Health does not disclose the identity of health plans and third-party administration firms that participate in the Data Contribution program. However, more than 60 companies representing over 150 million individuals covered by private health insurance contribute data to FAIR Health’s program, ensuring that healthcare professionals have access to robust data across the United States.

What methodologies are used to organize the data?

Benchmarks available through the FH Fee Estimator represent the distribution of actual charge data. When there are not enough occurrences of a specific procedure in a given geographic area to create a benchmark, a relative value methodology is used to derive a benchmark charge. More information about FAIR Health data methodologies is available here.

What is the difference between the FH Fee Estimator and the Cost Look-Up tools available at www.fairhealthconsumer.org?

FAIR Health operates a free website for consumers at www.fairhealthconsumer.org where consumers can estimate the costs of their own medical and dental procedures and learn about health insurance. Cost estimates available on the site are subject to search limits, which are imposed by FAIR Health’s licensing agreements with external parties and are required to ensure that searches are for individuals’ personal use and not for organizational or commercial purposes.

Through the FH Fee Estimator, healthcare professionals have unlimited access to detailed benchmark charge data. Annual, renewable data licenses are available at www.feeestimator.org for the FH Fee Estimator charge data by specialty and geographic location.

In addition, the FH Fee Estimator and the consumer website are updated on different schedules. For this reason, there may be differences based on when data are refreshed in each system.

FH Fee Estimator – Download

What is included in the FH Fee Estimator - Download product?

FH Fee Estimator - Download entitles healthcare professionals to download the data for the specialties and geographic areas they have licensed to an Excel file or a comma separated values (CSV) file. The file remains accessible through FH Fee Estimator for the term of the license agreement should the user need to download the data again.

Can I upgrade once I have licensed data through the FH Fee Estimator - Download product?

Yes. FH Fee Estimator Online offers flexible options for viewing, downloading and working with data online, and also provides a mid-year refresh of data. It also offers the easy-to-use FH Workbook that helps you use the data to inform the development of fee schedules and calculate practice revenues based on a number of variables. Upgrades are available for an annual license fee of $500, which is prorated based on the amount of time remaining on the original (download) data license.

FH Fee Estimator Online

What is included in FH Fee Estimator Online?

In addition to downloading licensed data directly to a computer, healthcare professionals using FH Fee Estimator Online can take advantage of flexible ways to display, organize and work with data online and refresh data mid-year. FH Fee Estimator Online includes the FH Workbook that makes it easy to compare practice data to benchmark market data, model fee schedules and calculate practice revenues under different billing scenarios.

What does FH Fee Estimator Online include that is not available in FH Fee Estimator - Download?

Both versions of FH Fee Estimator include the ability to download data directly to an Excel spreadsheet or CSV file. However, FH Fee Estimator Online offers valuable additional features that enable users to:

  • Access data anytime, from anywhere, using any common web browser;
  • Search for data by keyword or procedure code;
  • Select, view, download and print only the data points you need;
  • Choose from simple and advanced views of data formats;
  • Customize your data views;
  • Refresh data mid-year; and
  • Enter practice data into the FH Fee Estimator workbook to compare fees to market benchmarks, model fee schedules, evaluate contracts and manage other practice financial strategies.

Where do the data come from?

What is included in FH Fee Estimator Online?

More than 60 health insurance plans and third-party administrators, representing over 150 million individuals covered by private health insurance, contribute data to the FAIR Health database. FH Fee Estimator products draw data from FAIR Health’s database of billions of billed procedures.

Data contributors must submit all their data and attest that charges represent the full, non-discounted fees-for-service submitted by providers through the claims process. FAIR Health does not accept data contributions directly from healthcare professionals because of the potential for duplication of data included in the submissions from payors and administrators.

What methodologies are used to array the data?

FAIR Health makes its data available in multiple formats. The charge benchmarks presented in FH Fee Estimator products represent the spread of the actual charges for each procedure in each geozip, a location generally defined by the first three digits of a zip code. The actual charges reported for a code/geozip combination are arrayed from lowest to highest and organized into “percentiles.” A percentile represents the value below which a certain specified percentage of observations fall.

If the data for a given procedure code/geozip combination are not sufficient to produce a benchmark, a relative value methodology is used. The relative value methodology takes actual data as a starting point and applies statistical techniques including relative values and conversion factors to derive benchmark charge amounts. Relative values take into account the work performed by the provider (time, intensity, level of skill and training required), the expenses related to running the practice, including rent, equipment, supplies and cost of non-physician staff, and professional liability coverage.

FH Fee Estimator indicates which benchmarks have been developed with a relative value methodology. For more information about statistical methodologies used to develop FAIR Health products, please visit www.fairhealth.org/FHILibrary#Methodologies

How do I know the data are reliable?

FAIR Health works with the Upstate Health Research Network (UHRN), a consortium of health policy and economics researchers from leading universities around the country, who review and provide recommendations on the statistical methodologies that underlie the database.

The FAIR Health Scientific Advisory Board, a national advisory group, also conducts reviews of the statistical procedures proposed by the UHRN and advises FAIR Health management and the FAIR Health Board of Directors with respect to statistical methodologies.

In addition, FAIR Health’s staff of statistics and technology experts continually reviews the data and implements comprehensive quality assurance processes to maintain the integrity of the data.

The methodologies employed in compiling the database and producing FAIR Health products are subject to continuous review. Revisions are based on recommendations from FAIR Health expert advisory panels. FAIR Health is committed to providing transparency into how the data in the database are collected and compiled. More information about data methodologies can be found at www.fairhealth.org.

Customer Support

Is customer service available?

If you need assistance with FH Fee Estimator Online products or navigating the website, please call FAIR Health Customer Support at (855) 301-FAIR (3257) or email: service@fairhealth.org. Representatives are available from 9:00 AM - 6:00 pm Eastern Time, Monday - Friday. Outside of business hours, please leave a message and your call or email will be returned the next business day.

When can I obtain assistance?

Call FAIR Health Customer Support at (855) 301-FAIR (3257) or email service@fairhealth.org.

Billing and Payments

Can I pay by check? I prefer not to use a credit card.

Yes. Select "Pay by Check" during the checkout process. You can print an invoice and send it with your check to FAIR Health at the address provided. When your check is received, FAIR Health will email you instructions to access your data.

Is my credit card information secure?

Yes. FAIR Health uses Secure Sockets Layer (SSL) encryption technology to protect online transactions. In addition, credit card information will not be saved after your transaction, unless you enroll in our auto renewal program and authorize us to keep your credit card information on file.

How do you handle billing for tax-exempt organizations?

FAIR Health collects sales tax in the states where we are required to do so. If your organization has tax-exempt status and is in a state where sales tax is applied to your order, you have two options.

During the checkout process please select the box that says “My organization has tax-exempt status,” and:

1. If paying by credit card - complete the checkout process. You will be billed for the full amount plus sales tax. When your transaction is complete, we will contact you to request a copy of your tax-exempt certificate or other proof of tax-exempt status. Once we have received this supporting documentation, we will credit your card for the amount of the sales tax.

2. If paying by check - please send a copy of your tax-exempt certificate or other proof of tax-exempt status with your invoice and a check for the amount of the data product license agreement. Your invoice will be adjusted accordingly.

Can I pay through PayPal?

At present, we can accept payments only by credit card or check.

About FAIR Health

What is FAIR Health?

FAIR Health is a national, independent not-for-profit corporation dedicated to bringing transparency to healthcare costs and health insurance information. FAIR Health qualifies as a tax-exempt organization under Internal Revenue Code section 501(c3).

Why was FAIR Health established?

FAIR Health was established as part of a settlement agreement between health insurers and the Attorney General of New York State. Formed to provide transparency into health insurance costs and insurance information, FAIR Health operates a database of billions of medical and dental procedures billed through the private insurance system. In fulfillment of its mission, FAIR Health licenses access to this database through a range of data products to enable all stakeholders in the health insurance system to gain a window into healthcare costs.

What is the FAIR Health mission?

FAIR Health’s mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and support of scientific and economic research on medical and dental care. FAIR Health uses its database of billions of billed medical and dental services to power a free website (fairhealthconsumer.org) that enables consumers to estimate and plan their medical and dental expenditures. The website also offers clear, unbiased educational articles and videos about the healthcare insurance reimbursement system. In addition to its consumer offerings, FAIR Health licenses data products to businesses, government agencies, healthcare providers and researchers. With its professional staff of experts in healthcare, statistics, technology and communications, FAIR Health strives to offer accurate, consistent and timely information to all stakeholders in the healthcare system.

What other products/services does FAIR Health offer?

In addition to FH Fee Estimator for Healthcare Professionals, FAIR Health licenses a range of data products to meet the needs of multiple stakeholders in the healthcare system.

  • Data modules: nationwide data by category (Medical, Dental, Inpatient Facility, Outpatient Facility, Anesthesia, HCPCS and Allowed Medical);
  • Custom analytics;
  • FH NPIC℠ database for academic and policy researchers; and
  • Consumer Website: web-based medical and dental cost estimation tools, educational articles and videos.

Does FAIR Health’s non-profit status make a difference?

As an independent, not-for-profit corporation, FAIR Health offers objective, disinterested healthcare information for all stakeholders in the healthcare system. Because FAIR Health and its Board are not controlled by nor dependent on third parties, including association, corporate or other special interests in the healthcare arena, all stakeholders in the healthcare system can depend on FAIR Health as a source of reliable, unbiased healthcare cost data.

If FAIR Health is non-profit, why do you charge license fees?

FAIR Health is a not-for-profit corporation whose mission is to bring fairness and transparency to healthcare costs and insurance information. While FAIR Health was formed from a settlement agreement, it received only a portion of the settlement funds to develop an infrastructure to support its mission and to initiate operations. FAIR Health was given a mandate to become self-sufficient within only a few years after its formation. While the company provides free educational resources and services to consumers, it charges reasonable license fees for data products to ensure that the company can continue to operate and support its work for the long term.