# What Insurers Pay: Mass General Brigham Health Plan

The price Mass General Brigham Health Plan 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: 92
- zip codes: 570
- states: 34
- practices: 5,559
- prices as of: 2026-08-27

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

## 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 | 1.2x 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, doctor's fee | 1.8x 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, doctor's fee | 1.5x 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, doctor's 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, doctor's 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, doctor's 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, doctor's fee | 1.6x 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, doctor's 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 | 1.1x Medicare | [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 | 1.5x 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 | 1.1x 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 | about what Medicare pays | [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 | 1.5x 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 | 1.5x 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, doctor's 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, doctor's fee | 1.3x 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 and facility fees | 2.0x 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, doctor's fee | 1.6x Medicare | [table](statemap_93452_US.md) | [map](statemap_93452_US.html), [by county](countymap_93452_US.html) |
| Home health | Home health visit by a registered nurse (15 min) | G0299 | at home, doctor's fee |  | [table](statemap_G0299_US.md) | [map](statemap_G0299_US.html), [by county](countymap_G0299_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 | about what Medicare pays | [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 | 1.4x 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 | 1.3x 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 | 1.1x 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 | 1.6x 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 | 1.1x 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 | 1.8x 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 | 1.6x 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 | 1.6x 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 | 1.8x 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 | 1.4x Medicare | [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 | 1.4x 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 and facility fees | 1.4x 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 | 1.5x Medicare | [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 | 1.3x Medicare | [table](statemap_85610_US.md) | [map](statemap_85610_US.html), [by county](countymap_85610_US.html) |
| Labs & bloodwork | Blood draw | 36415 | office, doctor's and facility fees | 1.3x 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 | 1.5x Medicare | [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 and facility fees | 1.5x Medicare | [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 | 1.4x 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 | 1.4x Medicare | [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 | 1.4x Medicare | [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 | 1.4x Medicare | [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 | 1.5x Medicare | [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 | 1.5x Medicare | [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 | 1.5x Medicare | [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 | 1.4x 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 | 1.5x Medicare | [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 and facility fees | 1.4x 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 and facility fees | 1.2x 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 and facility fees | 1.1x 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 and facility fees | 1.2x 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 and facility fees | about what Medicare pays | [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 and facility fees | 1.1x 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 and facility fees | 1.1x 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 and facility fees | 1.1x 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 and facility fees | 1.1x 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 and facility fees | about what Medicare pays | [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 and facility fees | about what Medicare pays | [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 and facility fees | 1.1x 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 and facility fees | about what Medicare pays | [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 and facility fees | about what Medicare pays | [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 and facility fees | about what Medicare pays | [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 and facility fees | 1.1x Medicare | [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 and facility fees |  | [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 and facility fees |  | [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 and facility fees |  | [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 and facility fees |  | [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 and facility fees |  | [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 and facility fees |  | [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 | 1.4x 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, doctor's 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, doctor's 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, doctor's 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, doctor's fee | 1.3x 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, doctor's fee | 1.2x 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, doctor's fee | 1.3x 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, doctor's fee | 1.3x 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, doctor's fee | 1.7x 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, doctor's fee | 2.1x 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, doctor's fee | 1.3x 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 | about what Medicare pays | [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 | about what Medicare pays | [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 | 1.1x 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 | 1.1x 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 and facility fees | 1.4x Medicare | [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 | 1.4x 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 | 1.1x 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 | 1.1x 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 and facility fees | 1.4x Medicare | [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 and facility fees | 1.4x 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

Mass General Brigham Health Plan publishes its files at [its price transparency page](https://massgeneralbrighamhealthplan.org/meet-us/transparency-regulations). From there this build read **1 index file** naming 534 health plans (443 group-market, 91 individual-market), then downloaded **8 in-network rate files** (270.3 MB) on 2026-10-06.

From those, 347,850 price entries for 92 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 Mass General Brigham Health Plan’s entries mostly name a single practice (about 19 providers on average), so the 347,850 entries come to about **7 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 1 index files this was built from

- [Base](https://massgeneralbrighamhealthplan.org/pricetransparency/MRF/Base) — 534 plan(s), 14 rate file(s)

## Check it yourself

Everything here is public and verifiable:

- [Mass General Brigham Health Plan’s own file index](https://massgeneralbrighamhealthplan.org/meet-us/transparency-regulations) — 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 85 procedures below that Medicare prices, Mass General Brigham Health Plan’s typical price is **1.4x 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 27 show doctor's fee, 65 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 Mass General Brigham Health Plan 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**

- **Massachusetts**: about **$350.51** (4 of 6 parts priced; without the facility fee for Emergency visit, level 4, Troponin)
- **New Hampshire**: about **$296.46** (3 of 6 parts priced; without the facility fee for Emergency visit, level 4, the facility fee for EKG, read and traced (some hospitals bill 93005 + 93010 instead), Troponin)
- **Rhode Island**: about **$214.32** (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 **$167.18** (3 of 6 parts priced; without Complete blood count, Comprehensive metabolic panel, Troponin)
- **Maryland**: about **$179.10** (1 of 6 parts priced; without 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)
- **California**: about **$166.51** (2 of 6 parts priced; without Complete blood count, Comprehensive metabolic panel, the facility fee for EKG, read and traced (some hospitals bill 93005 + 93010 instead), Troponin)

- **Vaginal delivery with a hospital stay**

- **Massachusetts**: about **$3,239.05** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **New Hampshire**: about **$2,934.98** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **Rhode Island**: about **$2,934.98** (1 of 2 parts priced; without Hospital stay for the delivery (MS-DRG 807, no complications; not yet on our code list))
- **California**: about **$2,243.60** (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**

- **Massachusetts**: about **$264.30** (1 of 2 parts priced; without Surgery center or hospital outpatient facility fee for the same code)
- **New Hampshire**: about **$264.30** (1 of 2 parts priced; without Surgery center or hospital outpatient facility fee for the same code)
- **Rhode Island**: about **$220.25** (1 of 2 parts priced; without Surgery center or hospital outpatient facility fee for the same code)

## Who is counted

Mass General Brigham Health Plan mostly lists **practices, not individual clinicians**: 87% of the 5,559 provider IDs (NPIs) it names belong to a practice, clinic or hospital, which stands for everyone who works there. So “providers” here mostly counts practices — one entry can cover many doctors — and is not comparable with insurers that list each clinician. 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:

- Mental health care: Mass General Brigham Health Plan rents Optum's national behavioral health network. Its prices are Optum's, set nationwide, so they are not included here.
- Care outside New England: for some plans it rents UnitedHealthcare's and MultiPlan's national networks. Those prices are not included here.
- Hospital stays: Mass General Brigham Health Plan's files have no prices for whole hospital stays (the kind billed as one amount per stay), so there are no hospital-stay maps for it. It may pay hospitals by the day or as a share of their charges, which these maps cannot show.

## How the files read

Mass General Brigham Health Plan’s 1 index file name **8 in-network rate files** (dated 2026-08-26 to 2026-08-27). **8 were downloaded and 8 read** — every one. 2 files held no prices for the procedures mapped here.

## 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.