The new version of Cost Estimator is now live

As originally announced in November 2023, the new version of our Cost Estimator tool is now live for both members and providers. As a reminder, the primary change in this updated version is that it includes pricing and cost-sharing information for all covered procedures and services, in response to the “transparency in coverage” rule from the federal departments of Health and Human Services, Treasury and Labor.

How do I access Cost Estimator?

Providers still access Cost Estimator through prism. However, rather than it being in a separate tab on the Resources menu, it is now accessed through Member Inquiry. See this provider guide for instructions on how to access it.

Where can I get questions about this new version of Cost Estimator answered?

We’ve created this FAQ document to answer many of the questions you may have, including questions about:

  • Why we made this change
  • How Cost Estimator defines “fair price”
  • How cost estimates are calculated
  • PriorityRewards
  • Updated rates and how these factor into the cost estimates

Why should I use Cost Estimator?

The way people shop for health care continues to change. Consumers are looking for cost transparency and want to know what they are paying for, the same as if they were shopping for a new car or appliance. Talking about costs with your patients, using data from Cost Estimator, can allow you to meet them where they are and help them get the care they need at the right price.

Please encourage your patients to research the cost of their care and have your staff use Cost Estimator when they’re helping a patient with a referral for tests and procedures.