Prices shown: surgery centers and hospital outpatient departments
Doctor’s fee or facility fee? These are facility fees: what the insurer pays the hospital or surgery center itself. The doctors who treat you bill separately, on top of it.
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. EmblemHealth’s files name 182 providers for this procedure; 117 are counted here: the clinicians whose specialty performs it — mostly General Acute Care Hospital, Clinic/Center and Surgery — and the practices, clinics and hospitals. Insurers attach their whole fee schedule to every contracted provider, so the rest are clinicians listed at a price for something they never do; counting them would inflate the provider count and pull the typical price towards the fee schedule’s floor.
Not on this map: 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.
State
Providers
Named in files
Organisations
Zip codes
Lowest
25th pct
Median
75th pct
Highest
vs Medicare
“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) — the lower price a doctor is paid when a hospital or surgery center provides the room and equipment. 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. The prices on this map include a facility fee, which Medicare pays separately and which is not in its physician price, so the ratio here runs high and is a rough guide only.
This is a statewide summary. Prices vary far more between towns and between practices than these medians suggest; zip-code and provider-level detail is not published here; this specific data can be requested here.