stage-surprisebilling.fairhealth.org
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https://stage-surprisebilling.fairhealth.org/
Submission: On November 09 via automatic, source certstream-suspicious — Scanned from DE
Submission: On November 09 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 2 forms found in the DOM
<form id="cse-search-box" action="" onsubmit="return search_go('searchbarterm');return false;">
<input type="text" id="searchbarterm" name="searchbarterm" placeholder="Search">
</form>POST
<form action="" method="post" id="cart_submit" autocomplete="off" onsubmit="">
<input type="hidden" name="_token" value="VSeVL6AMY03mz3bWr4JynpjWJebLO1JLlHwL9IVh">
<div class="row justify-content-center no-gutters">
<div class="col-md-10" id="product-container">
<div class="row justify-content-around">
<div class="col-12" id="product-summary">
<div id="product-title">SURPRISE BILLING DATA PRODUCT ORDERS FOR SMALL MEDICAL PRACTICES</div>
<p>FAIR Health has provided this website to allow licensed healthcare providers in solo or small medical practices (fewer than 5 licensed medical professionals) to purchase a license for FAIR Health data products in connection with state
surprise billing laws. This site is not intended for use by bill review or revenue cycle management companies, consultants, insurers, payors, or others. If you are not a solo or small medical practice, please call (855) 301-FAIR (3247) or
email service@fairhealth.org and a member of the FAIR Health team will be pleased to discuss license options.</p>
</div>
</div>
<div class="row justify-content-around">
<div class="col-12">
<div id="accordion">
<div class="card">
<div class="card-header" id="headingGA">
<div class="row collapsed" data-toggle="collapse" data-target="#collapseGA" aria-expanded="true" aria-controls="collapseGA">
<div class="col-sm-4 col-md-2 col-3 col-lg-2 product_cat_image"><img src="/images/Georgia_Seal.svg"></div>
<div class="col-sm-8 col-md-10 col-9 col-lg-10 align-self-center">
<div class="state-title">Georgia Surprise Billing Benchmarks</div>
</div>
</div>
</div>
<div id="collapseGA" class="collapse " aria-labelledby="headingGA" data-parent="#accordion">
<div class="card-body container">
<div class="row">
<div class="input-row col-12">
<div class="row category-row-description">
<div class="col-12">
<div class="category-note-title">Please select one or more clinical specialties *</div>
<div class="category-note">The licensing fee for each specialty is $250. Products include all geographic areas within the state, organized by “geozips”, generally based on the first three digits of a zip code or group of zip
codes. Access to licensed products will be granted through our web-based query tool, <span style="white-space: nowrap">FH Online</span>.</div>
</div>
</div>
</div>
<div class="input-row col-12">
<div class="row product-row GA">
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[111]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="All"> All
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[112]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Anesthesia"> Anesthesia
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[113]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Allergy/Immunology"> Allergy/Immunology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[114]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Audiology"> Audiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[115]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Behavioral Health"> Behavioral Health
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[116]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Cardiac Surgery/Thoracic Surgery"> Cardiac Surgery/Thoracic Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[117]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Cardiology"> Cardiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[118]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Chiropractic"> Chiropractic
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[119]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Colorectal Surgery"> Colorectal Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[120]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Dermatology"> Dermatology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[121]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Emergency Medicine"> Emergency Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[122]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Family Practice"> Family Practice
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[123]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Gastroenterology"> Gastroenterology
</div>
<!-- Products - years/med -->
</div>
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[124]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="General Surgery"> General Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[125]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Hand Surgery"> Hand Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[126]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Hematology/Oncology"> Hematology/Oncology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[127]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Internal Medicine"> Internal Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[128]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Laboratory Codes"> Laboratory Codes
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[129]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Nephrology"> Nephrology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[130]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Neurology"> Neurology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[131]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Neurosurgery"> Neurosurgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[132]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Nuclear Medicine"> Nuclear Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[133]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Obstetrics/Gynecology"> Obstetrics/Gynecology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[134]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Opthalmology"> Opthalmology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[135]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Oral Maxillofacial Surgery"> Oral Maxillofacial Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[136]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Orthopedic Surgery"> Orthopedic Surgery
</div>
<!-- Products - years/med -->
</div>
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[137]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Otolaryngology"> Otolaryngology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[138]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pain Management"> Pain Management
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[139]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pathology"> Pathology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[140]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pediatrics"> Pediatrics
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[141]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Plastic and Reconstructive Surgery"> Plastic and Reconstructive Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[142]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Podiatry"> Podiatry
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[143]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pulmonary Disease"> Pulmonary Disease
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[144]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Radiation Oncology"> Radiation Oncology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[145]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Radiology"> Radiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[146]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Urology"> Urology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[147]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Vascular Surgery"> Vascular Surgery
</div>
<!-- Products - years/med -->
</div>
<!-- Products - years/med -->
</div>
<div class="row product-row">
<div class="col-12">
<div class="footnote internal-med ">Internal Medicine includes codes for Endocrinology, Geriatric Medicine, Infectious Disease, Physical Medicine and Rehabilitation and Rheumatology specialties Obstetrics/Gynecology includes
Gynecology, Obstetrics and Gynecology Oncology.</div>
<div class="footnote pathology ">All Medical specialties except pathology include evaluation and management codes</div>
</div>
</div>
<div class="row product-row">
<div class="col-12 product-select">
<div class="product-quantity">
<div class="category-note-title">License Fees</div>
<div class="category-note">$250 per each clinical specialty selected, plus $60 for each additional user. </div>
<div class="license-container">
<input type="text" size="3" maxlength="4" class="license textbox_small " name="cart[148]" value="0" onkeypress="return keyRestrict(event,'1234567890')" title="Additional User" disabled="">
<label class="license-label">Additional Users <br> (+$60.00) </label>
</div>
<div class="product-disclaimer">A "<b>User</b>" is defined as an individual who accesses, uses, or manipulates the Data Products, produces or enables an output from the Data Products (data, reports or the like), or who
uses, or benefits from, any outputs from the Data Products. </div>
<div class="product-disclaimer">
<em><b>Note: You must include all practitioners and billing staff in your practice(fewer than 5 licensed medical professionals) in the total “User” count, as well as other individuals who use or benefit from the Data Products.</b>
For example, you should count all doctors and other practitioners in your practice for the clinical service area purchased; your office billing staff who may use the data to prepare or manage bills for those
practitioners; and any other individuals who might use the data in managing the practice, such as executive management or finance staff.</em>
</div>
</div>
</div>
</div>
</div> <!-- end product-container -->
</div><!-- end row -->
<!-- Category -->
</div><!-- end card-body -->
</div> <!-- end collapse -->
</div><!-- end card -->
<div class="card">
<div class="card-header" id="headingNM">
<div class="row collapsed" data-toggle="collapse" data-target="#collapseNM" aria-expanded="true" aria-controls="collapseNM">
<div class="col-sm-4 col-md-2 col-3 col-lg-2 product_cat_image"><img src="/images/nm_seal.png"></div>
<div class="col-sm-8 col-md-10 col-9 col-lg-10 align-self-center">
<div class="state-title">New Mexico Surprise Billing Benchmarks</div>
</div>
</div>
</div>
<div id="collapseNM" class="collapse " aria-labelledby="headingNM" data-parent="#accordion">
<div class="card-body container">
<div class="row">
<div class="input-row col-12">
<div class="row category-row-description">
<div class="col-12">
<div class="category-note-title">Please select one or more clinical specialties *</div>
<div class="category-note">The licensing fee for each specialty is $250. Products include all geographic areas within the state, organized by “geozips”, generally based on the first three digits of a zip code or group of zip
codes. Access to licensed products will be granted through our web-based query tool, <span style="white-space: nowrap">FH Online</span>.</div>
</div>
</div>
</div>
<div class="input-row col-12">
<div class="row product-row NM">
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[1]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="All"> All
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[4]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Anesthesia"> Anesthesia
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[7]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Allergy/Immunology"> Allergy/Immunology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[10]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Audiology"> Audiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[13]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Behavioral Health"> Behavioral Health
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[16]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Cardiac Surgery/Thoracic Surgery"> Cardiac Surgery/Thoracic Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[19]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Cardiology"> Cardiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[22]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Chiropractic"> Chiropractic
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[25]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Colorectal Surgery"> Colorectal Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[28]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Dermatology"> Dermatology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[31]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Emergency Medicine"> Emergency Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[34]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Family Practice"> Family Practice
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[37]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Gastroenterology"> Gastroenterology
</div>
<!-- Products - years/med -->
</div>
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[40]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="General Surgery"> General Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[43]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Hand Surgery"> Hand Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[46]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Hematology/Oncology"> Hematology/Oncology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[49]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Internal Medicine"> Internal Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[52]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Laboratory Codes"> Laboratory Codes
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[55]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Nephrology"> Nephrology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[58]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Neurology"> Neurology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[61]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Neurosurgery"> Neurosurgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[64]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Nuclear Medicine"> Nuclear Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[67]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Obstetrics/Gynecology"> Obstetrics/Gynecology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[70]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Opthalmology"> Opthalmology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[73]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Oral Maxillofacial Surgery"> Oral Maxillofacial Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[76]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Orthopedic Surgery"> Orthopedic Surgery
</div>
<!-- Products - years/med -->
</div>
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[79]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Otolaryngology"> Otolaryngology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[82]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pain Management"> Pain Management
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[85]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pathology"> Pathology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[88]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pediatrics"> Pediatrics
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[91]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Plastic and Reconstructive Surgery"> Plastic and Reconstructive Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[94]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Podiatry"> Podiatry
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[97]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pulmonary Disease"> Pulmonary Disease
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[100]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Radiation Oncology"> Radiation Oncology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[103]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Radiology"> Radiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[106]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Urology"> Urology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[109]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Vascular Surgery"> Vascular Surgery
</div>
<!-- Products - years/med -->
</div>
<!-- Products - years/med -->
</div>
<div class="row product-row">
<div class="col-12">
<div class="footnote internal-med ">Internal Medicine includes codes for Endocrinology, Geriatric Medicine, Infectious Disease, Physical Medicine and Rehabilitation and Rheumatology specialties Obstetrics/Gynecology includes
Gynecology, Obstetrics and Gynecology Oncology.</div>
<div class="footnote pathology ">All Medical specialties except pathology include evaluation and management codes</div>
</div>
</div>
<div class="row product-row">
<div class="col-12 product-select">
<div class="product-quantity">
<div class="category-note-title">License Fees</div>
<div class="category-note">$250 per each clinical specialty selected, plus $60 for each additional user. </div>
<div class="license-container">
<input type="text" size="3" maxlength="4" class="license textbox_small " name="cart[149]" value="0" onkeypress="return keyRestrict(event,'1234567890')" title="Additional User" disabled="">
<label class="license-label">Additional Users <br> (+$60.00) </label>
</div>
<div class="product-disclaimer">A "<b>User</b>" is defined as an individual who accesses, uses, or manipulates the Data Products, produces or enables an output from the Data Products (data, reports or the like), or who
uses, or benefits from, any outputs from the Data Products. </div>
<div class="product-disclaimer">
<em><b>Note: You must include all practitioners and billing staff in your practice(fewer than 5 licensed medical professionals) in the total “User” count, as well as other individuals who use or benefit from the Data Products.</b>
For example, you should count all doctors and other practitioners in your practice for the clinical service area purchased; your office billing staff who may use the data to prepare or manage bills for those
practitioners; and any other individuals who might use the data in managing the practice, such as executive management or finance staff.</em>
</div>
</div>
</div>
</div>
</div> <!-- end product-container -->
</div><!-- end row -->
<!-- Category -->
</div><!-- end card-body -->
</div> <!-- end collapse -->
</div><!-- end card -->
<div class="card">
<div class="card-header" id="headingTX">
<div class="row collapsed" data-toggle="collapse" data-target="#collapseTX" aria-expanded="true" aria-controls="collapseTX">
<div class="col-sm-4 col-md-2 col-3 col-lg-2 product_cat_image"><img src="/images/texas_seal.png"></div>
<div class="col-sm-8 col-md-10 col-9 col-lg-10 align-self-center">
<div class="state-title">Texas Surprise Billing Benchmarks</div>
</div>
</div>
</div>
<div id="collapseTX" class="collapse " aria-labelledby="headingTX" data-parent="#accordion">
<div class="card-body container">
<div class="row">
<div class="input-row col-12">
<div class="row category-row-description">
<div class="col-12">
<div class="category-note-title">Please select one or more clinical specialties *</div>
<div class="category-note">The licensing fee for each specialty is $250. Products include all geographic areas within the state, organized by “geozips”, generally based on the first three digits of a zip code or group of zip
codes. Access to licensed products will be granted through our web-based query tool, <span style="white-space: nowrap">FH Online</span>.</div>
</div>
</div>
</div>
<div class="input-row col-12">
<div class="row product-row TX">
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[2]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="All"> All
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[5]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Anesthesia"> Anesthesia
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[8]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Allergy/Immunology"> Allergy/Immunology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[11]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Audiology"> Audiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[14]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Behavioral Health"> Behavioral Health
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[17]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Cardiac Surgery/Thoracic Surgery"> Cardiac Surgery/Thoracic Surgery
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[20]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Cardiology"> Cardiology
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[23]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Chiropractic"> Chiropractic
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<input type="checkbox" class="textbox_small input-value" name="cart[26]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Colorectal Surgery"> Colorectal Surgery
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[29]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Dermatology"> Dermatology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[32]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Emergency Medicine"> Emergency Medicine
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[35]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Family Practice"> Family Practice
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[44]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Hand Surgery"> Hand Surgery
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[47]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Hematology/Oncology"> Hematology/Oncology
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[53]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Laboratory Codes"> Laboratory Codes
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<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[59]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Neurology"> Neurology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[62]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Neurosurgery"> Neurosurgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[65]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Nuclear Medicine"> Nuclear Medicine
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[68]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Obstetrics/Gynecology"> Obstetrics/Gynecology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[71]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Opthalmology"> Opthalmology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[74]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Oral Maxillofacial Surgery"> Oral Maxillofacial Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[77]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Orthopedic Surgery"> Orthopedic Surgery
</div>
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</div>
<div class="product-select col-12 col-sm-6 col-lg-4">
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[80]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Otolaryngology"> Otolaryngology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[83]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pain Management"> Pain Management
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[86]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pathology"> Pathology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[89]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pediatrics"> Pediatrics
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[92]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Plastic and Reconstructive Surgery"> Plastic and Reconstructive Surgery
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[95]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Podiatry"> Podiatry
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[98]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Pulmonary Disease"> Pulmonary Disease
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[101]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Radiation Oncology"> Radiation Oncology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[104]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Radiology"> Radiology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[107]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Urology"> Urology
</div>
<div class="product-quantity">
<input type="checkbox" class="textbox_small input-value" name="cart[110]" value="1" onkeypress="return keyRestrict(event,'1234567890')" title="Vascular Surgery"> Vascular Surgery
</div>
<!-- Products - years/med -->
</div>
<!-- Products - years/med -->
</div>
<div class="row product-row">
<div class="col-12">
<div class="footnote internal-med ">Internal Medicine includes codes for Endocrinology, Geriatric Medicine, Infectious Disease, Physical Medicine and Rehabilitation and Rheumatology specialties Obstetrics/Gynecology includes
Gynecology, Obstetrics and Gynecology Oncology.</div>
<div class="footnote pathology ">All Medical specialties except pathology include evaluation and management codes</div>
</div>
</div>
<div class="row product-row">
<div class="col-12 product-select">
<div class="product-quantity">
<div class="category-note-title">License Fees</div>
<div class="category-note">$250 per each clinical specialty selected, plus $60 for each additional user. </div>
<div class="license-container">
<input type="text" size="3" maxlength="4" class="license textbox_small " name="cart[150]" value="0" onkeypress="return keyRestrict(event,'1234567890')" title="Additional User" disabled="">
<label class="license-label">Additional Users <br> (+$60.00) </label>
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<div class="product-disclaimer">A "<b>User</b>" is defined as an individual who accesses, uses, or manipulates the Data Products, produces or enables an output from the Data Products (data, reports or the like), or who
uses, or benefits from, any outputs from the Data Products. </div>
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For example, you should count all doctors and other practitioners in your practice for the clinical service area purchased; your office billing staff who may use the data to prepare or manage bills for those
practitioners; and any other individuals who might use the data in managing the practice, such as executive management or finance staff.</em>
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* * About Us * Data * Who We Serve * Solutions * Research * Grants * Publications * Newsroom * About Us * Data * Who We Serve * Solutions * Research * Grants * Publications * Newsroom THE NATION’S LARGEST REPOSITORY OF PRIVATE CLAIMS DATA Monthly Telehealth Regional Tracker LEARN MORE SURPRISE BILLING DATA PRODUCT ORDERS FOR SMALL MEDICAL PRACTICES FAIR Health has provided this website to allow licensed healthcare providers in solo or small medical practices (fewer than 5 licensed medical professionals) to purchase a license for FAIR Health data products in connection with state surprise billing laws. This site is not intended for use by bill review or revenue cycle management companies, consultants, insurers, payors, or others. If you are not a solo or small medical practice, please call (855) 301-FAIR (3247) or email service@fairhealth.org and a member of the FAIR Health team will be pleased to discuss license options. Georgia Surprise Billing Benchmarks Please select one or more clinical specialties * The licensing fee for each specialty is $250. Products include all geographic areas within the state, organized by “geozips”, generally based on the first three digits of a zip code or group of zip codes. Access to licensed products will be granted through our web-based query tool, FH Online. All Anesthesia Allergy/Immunology Audiology Behavioral Health Cardiac Surgery/Thoracic Surgery Cardiology Chiropractic Colorectal Surgery Dermatology Emergency Medicine Family Practice Gastroenterology General Surgery Hand Surgery Hematology/Oncology Internal Medicine Laboratory Codes Nephrology Neurology Neurosurgery Nuclear Medicine Obstetrics/Gynecology Opthalmology Oral Maxillofacial Surgery Orthopedic Surgery Otolaryngology Pain Management Pathology Pediatrics Plastic and Reconstructive Surgery Podiatry Pulmonary Disease Radiation Oncology Radiology Urology Vascular Surgery Internal Medicine includes codes for Endocrinology, Geriatric Medicine, Infectious Disease, Physical Medicine and Rehabilitation and Rheumatology specialties Obstetrics/Gynecology includes Gynecology, Obstetrics and Gynecology Oncology. All Medical specialties except pathology include evaluation and management codes License Fees $250 per each clinical specialty selected, plus $60 for each additional user. Additional Users (+$60.00) A "User" is defined as an individual who accesses, uses, or manipulates the Data Products, produces or enables an output from the Data Products (data, reports or the like), or who uses, or benefits from, any outputs from the Data Products. Note: You must include all practitioners and billing staff in your practice(fewer than 5 licensed medical professionals) in the total “User” count, as well as other individuals who use or benefit from the Data Products. For example, you should count all doctors and other practitioners in your practice for the clinical service area purchased; your office billing staff who may use the data to prepare or manage bills for those practitioners; and any other individuals who might use the data in managing the practice, such as executive management or finance staff. New Mexico Surprise Billing Benchmarks Please select one or more clinical specialties * The licensing fee for each specialty is $250. Products include all geographic areas within the state, organized by “geozips”, generally based on the first three digits of a zip code or group of zip codes. Access to licensed products will be granted through our web-based query tool, FH Online. All Anesthesia Allergy/Immunology Audiology Behavioral Health Cardiac Surgery/Thoracic Surgery Cardiology Chiropractic Colorectal Surgery Dermatology Emergency Medicine Family Practice Gastroenterology General Surgery Hand Surgery Hematology/Oncology Internal Medicine Laboratory Codes Nephrology Neurology Neurosurgery Nuclear Medicine Obstetrics/Gynecology Opthalmology Oral Maxillofacial Surgery Orthopedic Surgery Otolaryngology Pain Management Pathology Pediatrics Plastic and Reconstructive Surgery Podiatry Pulmonary Disease Radiation Oncology Radiology Urology Vascular Surgery Internal Medicine includes codes for Endocrinology, Geriatric Medicine, Infectious Disease, Physical Medicine and Rehabilitation and Rheumatology specialties Obstetrics/Gynecology includes Gynecology, Obstetrics and Gynecology Oncology. All Medical specialties except pathology include evaluation and management codes License Fees $250 per each clinical specialty selected, plus $60 for each additional user. Additional Users (+$60.00) A "User" is defined as an individual who accesses, uses, or manipulates the Data Products, produces or enables an output from the Data Products (data, reports or the like), or who uses, or benefits from, any outputs from the Data Products. Note: You must include all practitioners and billing staff in your practice(fewer than 5 licensed medical professionals) in the total “User” count, as well as other individuals who use or benefit from the Data Products. For example, you should count all doctors and other practitioners in your practice for the clinical service area purchased; your office billing staff who may use the data to prepare or manage bills for those practitioners; and any other individuals who might use the data in managing the practice, such as executive management or finance staff. Texas Surprise Billing Benchmarks Please select one or more clinical specialties * The licensing fee for each specialty is $250. Products include all geographic areas within the state, organized by “geozips”, generally based on the first three digits of a zip code or group of zip codes. Access to licensed products will be granted through our web-based query tool, FH Online. All Anesthesia Allergy/Immunology Audiology Behavioral Health Cardiac Surgery/Thoracic Surgery Cardiology Chiropractic Colorectal Surgery Dermatology Emergency Medicine Family Practice Gastroenterology General Surgery Hand Surgery Hematology/Oncology Internal Medicine Laboratory Codes Nephrology Neurology Neurosurgery Nuclear Medicine Obstetrics/Gynecology Opthalmology Oral Maxillofacial Surgery Orthopedic Surgery Otolaryngology Pain Management Pathology Pediatrics Plastic and Reconstructive Surgery Podiatry Pulmonary Disease Radiation Oncology Radiology Urology Vascular Surgery Internal Medicine includes codes for Endocrinology, Geriatric Medicine, Infectious Disease, Physical Medicine and Rehabilitation and Rheumatology specialties Obstetrics/Gynecology includes Gynecology, Obstetrics and Gynecology Oncology. All Medical specialties except pathology include evaluation and management codes License Fees $250 per each clinical specialty selected, plus $60 for each additional user. Additional Users (+$60.00) A "User" is defined as an individual who accesses, uses, or manipulates the Data Products, produces or enables an output from the Data Products (data, reports or the like), or who uses, or benefits from, any outputs from the Data Products. Note: You must include all practitioners and billing staff in your practice(fewer than 5 licensed medical professionals) in the total “User” count, as well as other individuals who use or benefit from the Data Products. For example, you should count all doctors and other practitioners in your practice for the clinical service area purchased; your office billing staff who may use the data to prepare or manage bills for those practitioners; and any other individuals who might use the data in managing the practice, such as executive management or finance staff. Add to Cart Contact Us: (855) 301-3247 or service@fairhealth.org Copyright © 2023 by FAIR Health | Privacy | Terms and Conditions