What is the Relative Cost of Network Providers?
UnitedHealthcare’s Relative Costs of Network Providers tool helps primary care providers (PCPs) make informed referral decisions for their patients who are our members.
Using this tool, you can search common services or treatments and view the relative costs of care providers for that service. When applicable, you can also view whether or not the care provider is a Premium® Care Physician1 who has been identified for quality and cost efficiency.
How It Works
This measurement compares care providers’ and facilities’ relative costs for specific services, by market. It also shows you whether or not a care provider is a Premium Care Physician, so you can consider quality as well as relative costs when making your referral decisions.
Please follow these steps to start using the directory:
- Go to the UnitedHealthcare General Provider Directory
- Choose Medical Directory
- Choose UnitedHealthcare Plans
- Choose ChoicePlus for the Plan (relative costs are available based on the ChoicePlus plans)
- Choose the Care by Condition / Cost Estimates category
- Select the service or treatment for which you would like relative cost information
- Select the option to have the tool find providers for the service or treatment estimate
What It Shows
The directory includes many common services, including office visits, preventive visits and select outpatient, inpatient, and laboratory and radiology services and procedures. The directory does not display specific contracted fees and rates, or specific cost estimates for a care provider. Rather, it displays where the provider falls on a spectrum of low-to-high costs relative to other providers who perform that service in the market area.
Methodology
We use the most commonly found procedure or diagnostic code in our historic claims data to come up with relative costs for services and procedures.
Cost Bands
We compare the estimated costs of one care provider to that of other care providers in the local area, and sort the care provider’s costs into one of the following levels:
- Below Average: The care provider’s estimate is in the lowest 25 percent in the local area.
- Meets Average: The care provider’s estimate is in the middle 50 percent in the local area.
- Above Average: The care provider’s estimate is in the highest 25 percent in the local area.
If a cost band is not displayed, a cost estimate is not available for that specific service from the care provider.
Cost banding is an estimate ‒ not a guarantee of a care provider’s specific cost. Certain geographic areas may not be available in the directory at this time.
The cost banding included in the directory represents cost estimates for services under Choice Plus commercial benefit plans and may not be representative of other UnitedHealthcare benefit plans. The information is updated quarterly. Provider-specific cost data used to develop the cost banding is based on current contracted fees for a provider, and if current contracted fees or rates are not available, historical claim average (median allowable) costs may be utilized.
For more information, contact your Network Representative.
1 For more information about the UnitedHealth Premium® Program, go to unitedhealthpremium.uhc.com
Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company, Oxford Health Insurance, Inc. or their affiliates. Health Plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California OBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, LLC, UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc., OptumRx, OptumHealth Care Solutions, LLC, Oxford Health Plans LLC or their affiliates. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH) or its affiliates.