# What Insurers Pay: EmblemHealth

The price EmblemHealth has already agreed to pay each doctor, for the same procedure, summarised by state. Prices for one procedure can differ several-fold between two practices a few miles apart.

- procedures mapped: 95
- zip codes: 10,865
- states: 54
- providers: 161,192
- prices as of: 2026-08-01

Web page, with the maps: https://medicalpricetransparency.netlify.app/insurers/emblem/

## Procedures

Each table gives the price in every state: providers, lowest, median and highest, and the median as a multiple of Medicare.

| Group | Procedure | Code | Price shown | Typical price vs Medicare | By state | Map |
|---|---|---|---|---|---|---|
| Cancer screening | Diagnostic mammogram, both breasts | 77066 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_77066_US.md) | [map](statemap_77066_US.html), [by county](countymap_77066_US.html) |
| Cancer screening | Diagnostic mammogram, one breast | 77065 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_77065_US.md) | [map](statemap_77065_US.html), [by county](countymap_77065_US.html) |
| Cancer screening | Screening colonoscopy (average risk) | G0121 | surgery center / hospital outpatient, facility fee | 1.5x Medicare | [table](statemap_G0121_US.md) | [map](statemap_G0121_US.html), [by county](countymap_G0121_US.html) |
| Cancer screening | Screening mammogram (routine) | 77067 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_77067_US.md) | [map](statemap_77067_US.html), [by county](countymap_77067_US.html) |
| Digestive procedures | Colonoscopy (diagnostic) | 45378 | surgery center / hospital outpatient, facility fee | 1.6x Medicare | [table](statemap_45378_US.md) | [map](statemap_45378_US.html), [by county](countymap_45378_US.html) |
| Digestive procedures | Colonoscopy with biopsy | 45380 | surgery center / hospital outpatient, facility fee | 1.6x Medicare | [table](statemap_45380_US.md) | [map](statemap_45380_US.html), [by county](countymap_45380_US.html) |
| Digestive procedures | Colonoscopy with polyp removal | 45385 | surgery center / hospital outpatient, facility fee | 1.5x Medicare | [table](statemap_45385_US.md) | [map](statemap_45385_US.html), [by county](countymap_45385_US.html) |
| Digestive procedures | Colonoscopy with ultrasound | 45391 | surgery center / hospital outpatient, facility fee | 1.5x Medicare | [table](statemap_45391_US.md) | [map](statemap_45391_US.html), [by county](countymap_45391_US.html) |
| Digestive procedures | Upper endoscopy (diagnostic) | 43235 | surgery center / hospital outpatient, facility fee | 1.5x Medicare | [table](statemap_43235_US.md) | [map](statemap_43235_US.html), [by county](countymap_43235_US.html) |
| Digestive procedures | Upper endoscopy with biopsy | 43239 | surgery center / hospital outpatient, facility fee | 1.6x Medicare | [table](statemap_43239_US.md) | [map](statemap_43239_US.html), [by county](countymap_43239_US.html) |
| Emergency & hospital | Emergency room visit (high complexity) | 99284 | emergency room, doctor's fee | about what Medicare pays | [table](statemap_99284_US.md) | [map](statemap_99284_US.html), [by county](countymap_99284_US.html) |
| Emergency & hospital | Emergency room visit (low complexity) | 99282 | emergency room, doctor's fee | 2.9x Medicare | [table](statemap_99282_US.md) | [map](statemap_99282_US.html), [by county](countymap_99282_US.html) |
| Emergency & hospital | Emergency room visit (moderate complexity) | 99283 | emergency room, doctor's fee | 1.6x Medicare | [table](statemap_99283_US.md) | [map](statemap_99283_US.html), [by county](countymap_99283_US.html) |
| Emergency & hospital | Emergency room visit (most complex) | 99285 | emergency room, doctor's fee | 0.7x Medicare | [table](statemap_99285_US.md) | [map](statemap_99285_US.html), [by county](countymap_99285_US.html) |
| Emergency & hospital | Hospital bedside visit, high complexity (per day) | 99233 | hospital stay, doctor's fee | 0.4x Medicare | [table](statemap_99233_US.md) | [map](statemap_99233_US.html), [by county](countymap_99233_US.html) |
| Emergency & hospital | Hospital bedside visit, moderate (per day) | 99232 | hospital stay, doctor's fee | 0.6x Medicare | [table](statemap_99232_US.md) | [map](statemap_99232_US.html), [by county](countymap_99232_US.html) |
| Eye care | Cataract surgery with lens implant | 66984 | surgery center / hospital outpatient, facility fee | 1.7x Medicare | [table](statemap_66984_US.md) | [map](statemap_66984_US.html), [by county](countymap_66984_US.html) |
| Eye care | Laser fix for cloudy vision after cataract surgery | 66821 | surgery center / hospital outpatient, facility fee | 1.2x Medicare | [table](statemap_66821_US.md) | [map](statemap_66821_US.html), [by county](countymap_66821_US.html) |
| Heart tests | Electrocardiogram (EKG) | 93000 | office, doctor's fee | 1.3x Medicare | [table](statemap_93000_US.md) | [map](statemap_93000_US.html), [by county](countymap_93000_US.html) |
| Heart tests | Heart catheterization (left heart) | 93452 | surgery center / hospital outpatient, facility fee | 0.8x Medicare | [table](statemap_93452_US.md) | [map](statemap_93452_US.html), [by county](countymap_93452_US.html) |
| Hospital stays (inpatient) | Heart valve surgery with catheterization (hospital stay) | 216 | hospital stay, facility fee | 2.2x Medicare | [table](statemap_216_US.md) | [map](statemap_216_US.html), [by county](countymap_216_US.html) |
| Hospital stays (inpatient) | Hip or knee replacement (hospital stay) | 470 | hospital stay, facility fee | 2.4x Medicare | [table](statemap_470_US.md) | [map](statemap_470_US.html), [by county](countymap_470_US.html) |
| Hospital stays (inpatient) | Neck spinal fusion (hospital stay) | 473 | hospital stay, facility fee | 2.4x Medicare | [table](statemap_473_US.md) | [map](statemap_473_US.html), [by county](countymap_473_US.html) |
| Hospital stays (inpatient) | Uterus or ovary surgery, non-cancer (hospital stay) | 743 | hospital stay, facility fee | 2.1x Medicare | [table](statemap_743_US.md) | [map](statemap_743_US.html), [by county](countymap_743_US.html) |
| Imaging & scans | Abdominal ultrasound (complete) | 76700 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_76700_US.md) | [map](statemap_76700_US.html), [by county](countymap_76700_US.html) |
| Imaging & scans | CT scan of abdomen and pelvis (with dye) | 74177 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_74177_US.md) | [map](statemap_74177_US.html), [by county](countymap_74177_US.html) |
| Imaging & scans | CT scan of the head (no dye) | 70450 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_70450_US.md) | [map](statemap_70450_US.html), [by county](countymap_70450_US.html) |
| Imaging & scans | CT scan of the pelvis (with dye) | 72193 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_72193_US.md) | [map](statemap_72193_US.html), [by county](countymap_72193_US.html) |
| Imaging & scans | Chest X-ray (single view) | 71045 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_71045_US.md) | [map](statemap_71045_US.html), [by county](countymap_71045_US.html) |
| Imaging & scans | Chest X-ray (two views) | 71046 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_71046_US.md) | [map](statemap_71046_US.html), [by county](countymap_71046_US.html) |
| Imaging & scans | Lower back X-ray (4+ views) | 72110 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_72110_US.md) | [map](statemap_72110_US.html), [by county](countymap_72110_US.html) |
| Imaging & scans | MRI of a leg joint (no dye) | 73721 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_73721_US.md) | [map](statemap_73721_US.html), [by county](countymap_73721_US.html) |
| Imaging & scans | MRI of the brain (no dye) | 70551 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_70551_US.md) | [map](statemap_70551_US.html), [by county](countymap_70551_US.html) |
| Imaging & scans | MRI of the brain (with and without dye) | 70553 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_70553_US.md) | [map](statemap_70553_US.html), [by county](countymap_70553_US.html) |
| Imaging & scans | MRI of the lower back (no dye) | 72148 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_72148_US.md) | [map](statemap_72148_US.html), [by county](countymap_72148_US.html) |
| Labs & bloodwork | Basic metabolic panel (BMP) | 80048 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_80048_US.md) | [map](statemap_80048_US.html), [by county](countymap_80048_US.html) |
| Labs & bloodwork | Basic urine test (automated) | 81003 | any setting, doctor's and facility fees | 1.1x Medicare | [table](statemap_81003_US.md) | [map](statemap_81003_US.html), [by county](countymap_81003_US.html) |
| Labs & bloodwork | Basic urine test (manual) | 81002 | any setting, doctor's fee | 0.8x Medicare | [table](statemap_81002_US.md) | [map](statemap_81002_US.html), [by county](countymap_81002_US.html) |
| Labs & bloodwork | Blood clotting test (PTT) | 85730 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_85730_US.md) | [map](statemap_85730_US.html), [by county](countymap_85730_US.html) |
| Labs & bloodwork | Blood clotting time test (PT/INR) | 85610 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_85610_US.md) | [map](statemap_85610_US.html), [by county](countymap_85610_US.html) |
| Labs & bloodwork | Blood draw | 36415 | office, doctor's fee | 0.3x Medicare | [table](statemap_36415_US.md) | [map](statemap_36415_US.html), [by county](countymap_36415_US.html) |
| Labs & bloodwork | Cholesterol test (lipid panel) | 80061 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_80061_US.md) | [map](statemap_80061_US.html), [by county](countymap_80061_US.html) |
| Labs & bloodwork | Complete blood count (CBC, basic) | 85027 | any setting, doctor's fee | about what Medicare pays | [table](statemap_85027_US.md) | [map](statemap_85027_US.html), [by county](countymap_85027_US.html) |
| Labs & bloodwork | Complete blood count with differential (CBC) | 85025 | any setting, doctor's and facility fees | 1.1x Medicare | [table](statemap_85025_US.md) | [map](statemap_85025_US.html), [by county](countymap_85025_US.html) |
| Labs & bloodwork | Comprehensive metabolic panel (CMP) | 80053 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_80053_US.md) | [map](statemap_80053_US.html), [by county](countymap_80053_US.html) |
| Labs & bloodwork | Hemoglobin A1c (3-month blood sugar) | 83036 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_83036_US.md) | [map](statemap_83036_US.html), [by county](countymap_83036_US.html) |
| Labs & bloodwork | Kidney function panel | 80069 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_80069_US.md) | [map](statemap_80069_US.html), [by county](countymap_80069_US.html) |
| Labs & bloodwork | Liver function panel | 80076 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_80076_US.md) | [map](statemap_80076_US.html), [by county](countymap_80076_US.html) |
| Labs & bloodwork | PSA prostate blood test (free) | 84154 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_84154_US.md) | [map](statemap_84154_US.html), [by county](countymap_84154_US.html) |
| Labs & bloodwork | PSA prostate blood test (total) | 84153 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_84153_US.md) | [map](statemap_84153_US.html), [by county](countymap_84153_US.html) |
| Labs & bloodwork | Thyroid blood test (TSH) | 84443 | any setting, doctor's and facility fees | 1.3x Medicare | [table](statemap_84443_US.md) | [map](statemap_84443_US.html), [by county](countymap_84443_US.html) |
| Labs & bloodwork | Urine test with microscope (automated) | 81001 | any setting, doctor's and facility fees | about what Medicare pays | [table](statemap_81001_US.md) | [map](statemap_81001_US.html), [by county](countymap_81001_US.html) |
| Labs & bloodwork | Urine test with microscope (manual) | 81000 | any setting, doctor's fee | 0.9x Medicare | [table](statemap_81000_US.md) | [map](statemap_81000_US.html), [by county](countymap_81000_US.html) |
| Mental health | Family or couples therapy (patient present) | 90847 | office, doctor's fee | 0.6x Medicare | [table](statemap_90847_US.md) | [map](statemap_90847_US.html), [by county](countymap_90847_US.html) |
| Mental health | Family therapy (without the patient present) | 90846 | office, doctor's fee | 0.6x Medicare | [table](statemap_90846_US.md) | [map](statemap_90846_US.html), [by county](countymap_90846_US.html) |
| Mental health | Group therapy session | 90853 | office, doctor's fee | 0.9x Medicare | [table](statemap_90853_US.md) | [map](statemap_90853_US.html), [by county](countymap_90853_US.html) |
| Mental health | Therapy session (30 minutes) | 90832 | office, doctor's fee | 0.4x Medicare | [table](statemap_90832_US.md) | [map](statemap_90832_US.html), [by county](countymap_90832_US.html) |
| Mental health | Therapy session (45 minutes) | 90834 | office, doctor's fee | 0.6x Medicare | [table](statemap_90834_US.md) | [map](statemap_90834_US.html), [by county](countymap_90834_US.html) |
| Mental health | Therapy session (60 minutes) | 90837 | office, doctor's fee | 0.4x Medicare | [table](statemap_90837_US.md) | [map](statemap_90837_US.html), [by county](countymap_90837_US.html) |
| Office visits | Office visit, existing patient (complex) | 99215 | office, doctor's fee | 0.3x Medicare | [table](statemap_99215_US.md) | [map](statemap_99215_US.html), [by county](countymap_99215_US.html) |
| Office visits | Office visit, existing patient (extended) | 99214 | office, doctor's fee | 0.3x Medicare | [table](statemap_99214_US.md) | [map](statemap_99214_US.html), [by county](countymap_99214_US.html) |
| Office visits | Office visit, existing patient (short) | 99212 | office, doctor's fee | 0.7x Medicare | [table](statemap_99212_US.md) | [map](statemap_99212_US.html), [by county](countymap_99212_US.html) |
| Office visits | Office visit, existing patient (standard) | 99213 | office, doctor's fee | 0.5x Medicare | [table](statemap_99213_US.md) | [map](statemap_99213_US.html), [by county](countymap_99213_US.html) |
| Office visits | Office visit, new patient (complex) | 99205 | office, doctor's fee | 0.4x Medicare | [table](statemap_99205_US.md) | [map](statemap_99205_US.html), [by county](countymap_99205_US.html) |
| Office visits | Office visit, new patient (extended) | 99204 | office, doctor's fee | 0.5x Medicare | [table](statemap_99204_US.md) | [map](statemap_99204_US.html), [by county](countymap_99204_US.html) |
| Office visits | Office visit, new patient (short) | 99202 | office, doctor's fee | 0.9x Medicare | [table](statemap_99202_US.md) | [map](statemap_99202_US.html), [by county](countymap_99202_US.html) |
| Office visits | Office visit, new patient (standard) | 99203 | office, doctor's fee | 0.6x Medicare | [table](statemap_99203_US.md) | [map](statemap_99203_US.html), [by county](countymap_99203_US.html) |
| Office visits | Quick office visit, existing patient | 99211 | office, doctor's fee | about what Medicare pays | [table](statemap_99211_US.md) | [map](statemap_99211_US.html), [by county](countymap_99211_US.html) |
| Office visits | Specialist consultation (extended) | 99244 | office, doctor's fee |  | [table](statemap_99244_US.md) | [map](statemap_99244_US.html), [by county](countymap_99244_US.html) |
| Office visits | Specialist consultation (standard) | 99243 | office, doctor's fee |  | [table](statemap_99243_US.md) | [map](statemap_99243_US.html), [by county](countymap_99243_US.html) |
| Preventive & wellness | Annual checkup, existing patient (age 18-39) | 99395 | office, doctor's fee |  | [table](statemap_99395_US.md) | [map](statemap_99395_US.html), [by county](countymap_99395_US.html) |
| Preventive & wellness | Annual checkup, existing patient (age 40-64) | 99396 | office, doctor's fee |  | [table](statemap_99396_US.md) | [map](statemap_99396_US.html), [by county](countymap_99396_US.html) |
| Preventive & wellness | Annual checkup, new patient (age 18-39) | 99385 | office, doctor's fee |  | [table](statemap_99385_US.md) | [map](statemap_99385_US.html), [by county](countymap_99385_US.html) |
| Preventive & wellness | Annual checkup, new patient (age 40-64) | 99386 | office, doctor's fee |  | [table](statemap_99386_US.md) | [map](statemap_99386_US.html), [by county](countymap_99386_US.html) |
| Sleep | Overnight sleep study (in a lab) | 95810 | any setting, doctor's and facility fees | 0.7x Medicare | [table](statemap_95810_US.md) | [map](statemap_95810_US.html), [by county](countymap_95810_US.html) |
| Spine & pain injections | Epidural steroid injection, lower back (no imaging) | 62322 | surgery center / hospital outpatient, facility fee | 1.3x Medicare | [table](statemap_62322_US.md) | [map](statemap_62322_US.html), [by county](countymap_62322_US.html) |
| Spine & pain injections | Epidural steroid injection, lower back (with imaging) | 62323 | surgery center / hospital outpatient, facility fee | 1.3x Medicare | [table](statemap_62323_US.md) | [map](statemap_62323_US.html), [by county](countymap_62323_US.html) |
| Spine & pain injections | Nerve root steroid injection, lower back | 64483 | surgery center / hospital outpatient, facility fee | 1.4x Medicare | [table](statemap_64483_US.md) | [map](statemap_64483_US.html), [by county](countymap_64483_US.html) |
| Surgery & procedures | Breast lump removal (open surgery) | 19120 | surgery center / hospital outpatient, facility fee | 1.4x Medicare | [table](statemap_19120_US.md) | [map](statemap_19120_US.html), [by county](countymap_19120_US.html) |
| Surgery & procedures | Gallbladder removal (laparoscopic) | 47562 | surgery center / hospital outpatient, facility fee | 4.3x Medicare | [table](statemap_47562_US.md) | [map](statemap_47562_US.html), [by county](countymap_47562_US.html) |
| Surgery & procedures | Groin hernia repair (age 5+) | 49505 | surgery center / hospital outpatient, facility fee | 1.6x Medicare | [table](statemap_49505_US.md) | [map](statemap_49505_US.html), [by county](countymap_49505_US.html) |
| Surgery & procedures | Knee arthroscopy - torn cartilage trim | 29881 | surgery center / hospital outpatient, facility fee | 1.6x Medicare | [table](statemap_29881_US.md) | [map](statemap_29881_US.html), [by county](countymap_29881_US.html) |
| Surgery & procedures | Prostate removal for cancer (laparoscopic) | 55866 | surgery center / hospital outpatient, facility fee | 1.6x Medicare | [table](statemap_55866_US.md) | [map](statemap_55866_US.html), [by county](countymap_55866_US.html) |
| Surgery & procedures | Shoulder arthroscopy for impingement | 29826 | surgery center / hospital outpatient, facility fee | 4.2x Medicare | [table](statemap_29826_US.md) | [map](statemap_29826_US.html), [by county](countymap_29826_US.html) |
| Surgery & procedures | Tonsil and adenoid removal (under 12) | 42820 | surgery center / hospital outpatient, facility fee | 1.4x Medicare | [table](statemap_42820_US.md) | [map](statemap_42820_US.html), [by county](countymap_42820_US.html) |
| Therapy & rehab | Physical therapy - balance and coordination (15 min) | 97112 | office, doctor's and facility fees | 1.4x Medicare | [table](statemap_97112_US.md) | [map](statemap_97112_US.html), [by county](countymap_97112_US.html) |
| Therapy & rehab | Physical therapy - functional activities (15 min) | 97530 | office, doctor's and facility fees | 1.4x Medicare | [table](statemap_97530_US.md) | [map](statemap_97530_US.html), [by county](countymap_97530_US.html) |
| Therapy & rehab | Physical therapy - hands-on manual therapy (15 min) | 97140 | office, doctor's and facility fees | 1.4x Medicare | [table](statemap_97140_US.md) | [map](statemap_97140_US.html), [by county](countymap_97140_US.html) |
| Therapy & rehab | Physical therapy - therapeutic exercise (15 min) | 97110 | office, doctor's and facility fees | 1.4x Medicare | [table](statemap_97110_US.md) | [map](statemap_97110_US.html), [by county](countymap_97110_US.html) |
| Women's health & maternity | C-section - full maternity care | 59510 | any setting, doctor's fee | about what Medicare pays | [table](statemap_59510_US.md) | [map](statemap_59510_US.html), [by county](countymap_59510_US.html) |
| Women's health & maternity | Pregnancy blood test panel | 80055 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_80055_US.md) | [map](statemap_80055_US.html), [by county](countymap_80055_US.html) |
| Women's health & maternity | Pregnancy ultrasound (after 14 weeks) | 76805 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_76805_US.md) | [map](statemap_76805_US.html), [by county](countymap_76805_US.html) |
| Women's health & maternity | Transvaginal pelvic ultrasound | 76830 | any setting, doctor's and facility fees | 1.2x Medicare | [table](statemap_76830_US.md) | [map](statemap_76830_US.html), [by county](countymap_76830_US.html) |
| Women's health & maternity | Vaginal birth after cesarean - full maternity care | 59610 | any setting, doctor's fee | about what Medicare pays | [table](statemap_59610_US.md) | [map](statemap_59610_US.html), [by county](countymap_59610_US.html) |
| Women's health & maternity | Vaginal childbirth - full maternity care | 59400 | any setting, doctor's fee | 1.1x Medicare | [table](statemap_59400_US.md) | [map](statemap_59400_US.html), [by county](countymap_59400_US.html) |

## What this data is

Since 2021, a federal rule called [Transparency in Coverage](https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage) has required health insurers to publish, **every month**, the rate they have negotiated with every provider in their network, for every billing code. Not an average, not a range — the actual contracted price, provider by provider.

The catch is that nobody can read them. They are published as raw JSON files running to gigabytes each, one per network, with providers referenced by numeric id rather than by name. They satisfy the rule without being of the slightest use to a patient. These maps are built directly from those files: every number here was published by the insurer, and nothing is estimated, modelled, or averaged from a survey.

## How this was built

EmblemHealth publishes its files at [its price transparency page](https://transparency.emblemhealth.com/INN). From there this build read **12 index files** naming 3,647,998 health plans (3,574,586 group-market, 73,412 individual-market), then downloaded **1720 in-network rate files** (13.0 GB) on 2026-10-06.

From those, 2,156,685 price entries for 95 common procedures were extracted, each provider looked up in the federal NPPES registry for their practice address, and the results grouped by zip code.

**That is a count of entries, not of prices.** An entry is one price together with the list of providers it applies to, and insurers write their files very differently: some state a price once for a whole network, others repeat it for every practice. Here EmblemHealth’s entries mostly name a single practice (about 90 providers on average), so the 2,156,685 entries come to about **194 million provider-level prices** (counting each network file separately). A big or small entry count says how an insurer writes its files, not how many prices it has — compare insurers on the maps, not on this number.

The 12 index files this was built from

- [2026-08-01_Emblemhealth_COM_index.zip](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_COM_index.zip&NetworkType=INN&FileType=Current) — 2,869,806 plan(s), 1713 rate file(s)
- [2026-08-01_Emblemhealth_GHI_index.zip](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_GHI_index.zip&NetworkType=INN&FileType=Current) — 650,784 plan(s), 1700 rate file(s)
- [2026-08-01_Emblemhealth_IDP_OFF_index.zip](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_IDP_OFF_index.zip&NetworkType=INN&FileType=Current) — 55,106 plan(s), 1505 rate file(s)
- [2026-08-01_Emblemhealth_ASO_index.zip](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_ASO_index.zip&NetworkType=INN&FileType=Current) — 32,052 plan(s), 1690 rate file(s)
- [2026-08-01_Emblemhealth_IDP_ON_index.zip](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_IDP_ON_index.zip&NetworkType=INN&FileType=Current) — 17,988 plan(s), 1126 rate file(s)
- [2026-08-01_Emblemhealth_EVICORE_index.json](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_EVICORE_index.json&NetworkType=INN&FileType=Current) — 3,729 plan(s), 1 rate file(s)
- [2026-08-01_Emblemhealth_BEACON_index.json](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_BEACON_index.json&NetworkType=INN&FileType=Current) — 3,557 plan(s), 2 rate file(s)
- [2026-08-01_Emblemhealth_QUALCARE_index.json](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_QUALCARE_index.json&NetworkType=INN&FileType=Current) — 3,494 plan(s), 2 rate file(s)
- [2026-08-01_Emblemhealth_HCP_index.json](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_HCP_index.json&NetworkType=INN&FileType=Current) — 3,238 plan(s), 1 rate file(s)
- [2026-08-01_Emblemhealth_EYEMED_index.json](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_EYEMED_index.json&NetworkType=INN&FileType=Current) — 3,050 plan(s), 1 rate file(s)
- [2026-08-01_Emblemhealth_GHI_ASO_index.zip](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_GHI_ASO_index.zip&NetworkType=INN&FileType=Current) — 2,788 plan(s), 1394 rate file(s)
- [2026-08-01_Emblemhealth_Montefiore_index.json](https://transparency.emblemhealth.com/Home/GetFile?FileName=2026-08-01_Emblemhealth_Montefiore_index.json&NetworkType=INN&FileType=Current) — 2,406 plan(s), 1 rate file(s)

## Check it yourself

Everything here is public and verifiable:

- [EmblemHealth’s own file index](https://transparency.emblemhealth.com/INN) — the source these maps are built from
- [CMS: Health Plan Price Transparency](https://www.cms.gov/priorities/healthplan-price-transparency/health-plan-price-transparency) — the government programme behind the rule, and what insurers must publish
- [The rule itself](https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage) (Federal Register, 2020)
- [CMS's technical guide and file schemas](https://github.com/CMSgov/price-transparency-guide) — what is actually inside the files, if you want to read them yourself
- [Hospital prices](../../hospitals/) on this site — built from the files hospitals publish under a separate rule, with cash prices and every insurer's rate at each hospital

## What the price means

Each price is what this insurer pays that provider for that billing code — the price **in the setting where that procedure is normally done**: an office visit in an office, an emergency visit in the emergency department, a hospital stay as an inpatient, a colonoscopy at a surgery center or hospital outpatient department. Procedures done everywhere, such as lab tests and scans, show every in-person setting. Telehealth rates are excluded, and so are prices for only part of a service: a scan's reading fee or equipment fee alone, an assistant surgeon's fee, a procedure that was not completed. Each procedure below, and each map, says which setting it shows.

**It is not what you will be billed.** What you pay depends on your deductible, copay and coinsurance; a visit usually includes more than one billing code; and a hospital-based practice may add a facility fee. Use these maps to compare providers, not to predict a bill.

**“x Medicare”** compares each price with what original Medicare pays a doctor for the same service in the same state under its physician fee schedule (RVU26D, in force from 2026-10-01). Insurers write their contracts as a share of Medicare, so 1.3x means the insurer pays 30% more than Medicare would; Medicare Advantage plans generally pay close to 1.0x. Across the 89 procedures below that Medicare prices, EmblemHealth’s typical price is **1.2x Medicare**; each procedure shows its own figure, and each map shows it state by state. Lab tests are compared with Medicare’s lab fee schedule and hospital stays with what Medicare paid hospitals in the state per stay; each map says which.

## Doctor’s fee or facility fee?

Care in a hospital or surgery center usually comes as **two separate bills**: the **doctor’s fee** (the “professional” fee, for the doctor’s own work) and the **facility fee** (the hospital or surgery center’s charge for the room, nurses and equipment). The facility fee is often the larger of the two, and many people do not know it is coming. A visit to an independent doctor’s office normally has no facility fee, but a clinic owned by a hospital may add one.

Insurers publish the two separately. **Every procedure below, and every map, says which one it shows**: here 35 show doctor's fee, 24 show facility fee, 36 show a mix of both.

## A whole visit, not one code

A visit is billed as several codes, each priced on its own. An emergency visit for chest pain is the visit code twice over (the doctor’s fee and the hospital’s facility fee), then blood tests, an EKG and a chest X-ray — and the tests vary more between hospitals than the visit code does. These are the typical totals EmblemHealth would pay in its largest states, adding up the median of each part; a part the files do not price there is left out and named.

- **ED visit with chest-pain workup**

- **California**: about **$176.54** (0 of 6 parts priced; without the facility fee for Emergency visit, level 4, Complete blood count, Comprehensive metabolic panel, the facility fee for EKG, read and traced (some hospitals bill 93005 + 93010 instead), the facility fee for Chest X-ray, two views, Troponin)
- **Texas**: about **$185.96** (0 of 6 parts priced; without the facility fee for Emergency visit, level 4, Complete blood count, Comprehensive metabolic panel, the facility fee for EKG, read and traced (some hospitals bill 93005 + 93010 instead), the facility fee for Chest X-ray, two views, Troponin)
- **Florida**: about **$176.66** (0 of 6 parts priced; without the facility fee for Emergency visit, level 4, Complete blood count, Comprehensive metabolic panel, the facility fee for EKG, read and traced (some hospitals bill 93005 + 93010 instead), the facility fee for Chest X-ray, two views, Troponin)
- **New York**: about **$250.00** (4 of 6 parts priced; without the facility fee for Emergency visit, level 4, Troponin)
- **Colorado**: about **$217.32** (2 of 6 parts priced; without the facility fee for Emergency visit, level 4, Complete blood count, Comprehensive metabolic panel, Troponin)
- **Virginia**: about **$178.97** (0 of 6 parts priced; without the facility fee for Emergency visit, level 4, Complete blood count, Comprehensive metabolic panel, the facility fee for EKG, read and traced (some hospitals bill 93005 + 93010 instead), the facility fee for Chest X-ray, two views, Troponin)

- **Vaginal delivery with a hospital stay**

- **New York**: about **$2,700.00** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **New Jersey**: about **$4,000.00** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **Pennsylvania**: about **$3,929.44** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **Connecticut**: about **$2,700.00** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **Florida**: about **$2,518.59** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **California**: about **$3,296.00** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))

- **Colonoscopy at a facility**

- **New York**: about **$278.40** (1 of 2 parts priced; without Doctor's fee for the colonoscopy)
- **New Jersey**: about **$642.00** (1 of 2 parts priced; without Doctor's fee for the colonoscopy)

## Who is counted

EmblemHealth lists clinicians individually: 98% of the 161,225 provider IDs (NPIs) it names are individual doctors, nurse practitioners and therapists; the rest are practices, clinics and hospitals. “Providers” counts those IDs. For each procedure, “providers” counts the clinicians whose specialty performs it, plus practices, clinics and hospitals. Insurers attach their whole fee schedule to every contracted provider, so their files name far more — family doctors and nurse practitioners listed at a price for a brain scan they will never do — and each map says how many were named.

## What this data may be missing

Some prices this insurer’s members pay are published somewhere else, so they are not on these maps:

- Care in New Jersey: for some plans, EmblemHealth rents the QualCare network. Its prices are QualCare's, so they are not included here.
- Montefiore's doctors and hospitals are missing: the Montefiore file EmblemHealth publishes dates from 2022, is not in the required format, and points to a provider list that is no longer there.
- These are EmblemHealth's August 2026 files - the newest it had published when this was built.
- Doctors EmblemHealth pays a flat monthly amount per patient (capitation) have no price per visit. For them its files carry a placeholder of ten cents, marked as a derived amount; those entries are left out, so such doctors may not appear on a map.

## How the files read

EmblemHealth’s 12 index files name **1,720 in-network rate files** (dated 2026-08-01 to 2026-08-20). **1,720 were downloaded and 1,720 read**. 1 of them needed repair on the way in (invalid characters or broken JSON that a strict reader rejects); their prices are included. 709 files held no prices for the procedures mapped here.

**1 file could not be fetched or read**, so their prices are missing:

- `2026-08-01_Montefiore-Delegation_EmblemHealth_in-network-rates.json` — 404 Client Error: Not Found for url: https://transparency.emblemhealth.com/NetworkFilesEH/In-Network/Current/2026-08-01_Montefiore-Delegation_EmblemHealth_in-ne

## Checked against hospitals’ own files

Hospitals publish, under a separate rule, what each insurer pays them. For **27 hospitals** whose own files name EmblemHealth, the price in EmblemHealth’s file and the price in the hospital’s file were compared for the same hospital stay (4 kinds of stay, 98 comparisons): **64% agree within 10%** and 82% within 25% or inside the range the hospital lists for EmblemHealth’s plans. On the whole the two sides agree almost exactly. At these hospitals EmblemHealth’s price for a stay is typically **3.3 times what Medicare paid the same hospital** for the same kind of stay in 2024 (22 comparisons). Two independent filings that match are the best check there is on either; the comparison covers hospital stays only, where both sides publish one facility price.

## What is not here

**These maps summarise a whole state.** Prices vary far more between two practices in one town than between two states, so a statewide median tells you what a procedure broadly costs, not what any particular provider charges. Zip-code and provider-level detail is not published here, but this data can be requested.

One insurer, one month, and only commercial plans — the rules do not cover Medicaid or Medicare Advantage, so those prices are not published at all. Out-of-network allowed amounts are published separately and are not included. Providers are placed at the practice address they registered with the federal NPI registry, which is sometimes a billing office rather than where they actually see patients.