FAIR Health’s Allowed and Charge Benchmarks Serve Many Uses

May 15, 2025

FAIR Health’s suite of FH^® Benchmarks includes both FH^® Allowed Benchmarks—which are based on negotiated, in-network allowed amounts for medical and dental services actually delivered to patients—and FH^® Charge Benchmarks, which are based on non-discounted, billed charges from providers. Both the allowed and charge benchmarks serve many uses in the healthcare sector.

All of FAIR Health’s benchmarks draw on our repository of over 51 billion commercial healthcare claim records, the nation’s largest such repository. The 75-plus payors and administrators who submit commercial claims data to our repository insure or process claims for both fully insured and self-insured plans, covering individuals located in all 50 states; Washington, DC; Puerto Rico; and the US Virgin Islands. FH Benchmarks aggregate records from this claims database across all payors and providers, filtering the data by official healthcare code (e.g., CPT^®1 and CDT^®2) and geozip (geographic area usually determined by the first three digits of a zip code); and array benchmarks for each procedure/geozip combination into percentiles.

Organized by service type, FH Benchmarks include the following:

• FH^® Allowed Benchmarks:
  • FH^® Allowed Medical;
  • FH^® Allowed Dental;
  • FH^® Allowed Anesthesia;
  • FH^® Allowed HCPCS;
  • FH^® Allowed Telehealth;
  • FH^® Allowed Inpatient Facility DRG;
  • FH^® Allowed Outpatient Facility;
  • FH^® Allowed ASC Facility; and
  • FH^® Allowed HCPCS Facility.
    
• FH^® Charge Benchmarks:
  • FH^® Charge Medical;
  • FH^® Charge Dental;
  • FH^® Charge Anesthesia;
  • FH^® Charge HCPCS;
  • FH^® Charge Telehealth;
  • FH^® Charge Inpatient Facility DRG;
  • FH^® Charge Outpatient Facility;
  • FH^® Charge ASC Facility; and
  • FH^® Charge HCPCS Facility.

FH Benchmarks are used in numerous ways, including establishing in- and out-of-network fee schedules, budgetary planning, billing, bill review and processing, dispute resolution, evaluating expansion into new market areas, adhering to statutory or regulatory programs incorporating FAIR Health benchmarks, business forecasting and evaluating outcomes of proposed healthcare policies. Healthcare stakeholders nationwide rely on FH Benchmarks, including payors, government entities, self-funded employers, providers and others. Thousands more use our data through third-party distributors or licensees who incorporate FAIR Health data into their products and services. FAIR Health benchmark data are used or officially approved by states for numerous purposes, including supporting surprise billing laws in Connecticut, Georgia, New Mexico, New York and Texas. FAIR Health’s FH^® NSA Reference File was specifically created to support compliance with the federal No Surprises Act. Both the FH NSA Reference File and FH Allowed Benchmarks may be used in arbitration and dispute resolution under the No Surprises Act.

For more information about FH Benchmarks, contact us by email at info@fairhealth.org or call us at 855-301-FAIR (3247), Monday through Friday, 9 am to 6 pm ET.

^{1 CPT © 2024 American Medical Association (AMA). All rights reserved.
2 Current Dental Terminology © American Dental Association. All rights reserved.}