Commercial healthcare reimbursement in Kentucky
How Kentucky compares with the nation, by payer, specialty and procedure.
Kentucky at a glance
What the data shows
Kentucky ranks 42nd of 51 states for commercial reimbursement, with an index of 88 (100 = national median) across 228 procedure codes; the South region averages 94.
Commercial rates in Kentucky run a median 133% of Medicare.
UnitedHealthcare has the highest index in the state (114) and Aetna the lowest (82), a 32-point gap, in the files analyzed.
CPT 51720 (Treatment of bladder lesion) is the strongest relative to the national median (106% of it, a 6% premium); CPT 76641 (Ultrasound breast complete) is furthest below (75% of the national median, 25% lower).
By specialty, Kentucky is strongest for cardiology (ranks 31st of 51 states for that specialty) and weakest for orthopedic surgery (46th of 51).
Against Medicare, gastroenterology has the highest ratio in Kentucky (171% of Medicare) and dermatology the lowest (85%).
Payer ranking in Kentucky
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 114 | 1 | 228 | 820 | 463 | |
| Cigna | 111 | 2 | 228 | 848 | 569 | |
| Blue Cross Blue Shield | 89 | 3 | 228 | 935 | 772 | |
| Aetna | 82 | 4 | 228 | 681 | 478 |
Reimbursement index by specialty in Kentucky
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Cardiology | 96 | 31 of 51 | 148% | 38 | 128 | |
| Gastroenterology | 93 | 34 of 50 | 171% | 36 | 124 | |
| Ophthalmology | 88 | 38 of 50 | 106% | 42 | 112 | |
| Urology | 91 | 39 of 50 | 147% | 37 | 116 | |
| Dermatology | 85 | 41 of 50 | 85% | 44 | 112 | |
| Internal medicine | 85 | 41 of 51 | 101% | 25 | 127 | |
| Diagnostic radiology | 85 | 46 of 51 | 127% | 49 | 134 | |
| Orthopedic surgery | 86 | 46 of 51 | 119% | 39 | 124 |
Specialty by payer in Kentucky
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 104 | 69 | 94 | 73 |
| Dermatology | 104 | 68 | 81 | 87 |
| Ophthalmology | 99 | 82 | 111 | 80 |
| Cardiology | 110 | 76 | 111 | 85 |
| Orthopedic surgery | 95 | 71 | 95 | 79 |
| Diagnostic radiology | 88 | 71 | 105 | 78 |
| Urology | 107 | 69 | 102 | 79 |
| Gastroenterology | 113 | 81 | 100 | 80 |
Kentucky compared with South region states
Procedures that pay most and least in Kentucky vs the nation
Highest vs national
| Code | Kentucky | National | Gap | Prov. |
|---|---|---|---|---|
| 51720 Treatment of bladder lesion | $118 | $111 | +6% | 116 |
| 93010 Electrocardiogram report | $13 | $13 | +5% | 128 |
| 93294 Rem interrog evl pm/ldls pm | $50 | $48 | +4% | 128 |
| 93016 Cv stress test supvj only | $35 | $34 | +3% | 128 |
| 51700 Irrigation of bladder | $79 | $77 | +2% | 116 |
| 43238 Egd us fine needle bx/aspir | $389 | $383 | +1% | 124 |
| 33361 Replace aortic valve perq | $1,966 | $1,938 | +1% | 128 |
| 52281 Cystoscopy and treatment | $338 | $334 | +1% | 116 |
| 33208 Insrt heart pm atrial & vent | $823 | $819 | +0% | 128 |
| 93925 Lower extremity study | $350 | $349 | +0% | 128 |
| 43264 Ercp remove duct calculi | $622 | $622 | +0% | 124 |
| 65778 Cover eye w/membrane | $70 | $70 | -0% | 112 |
| 43237 Endoscopic us exam esoph | $318 | $318 | -0% | 124 |
| 52000 Cystourethroscopy | $210 | $210 | -0% | 115 |
| 43246 Egd place gastrostomy tube | $336 | $338 | -1% | 124 |
Lowest vs national
| Code | Kentucky | National | Gap | Prov. |
|---|---|---|---|---|
| 76641 Ultrasound breast complete | $109 | $145 | -25% | 133 |
| 71271 Ct thorax lung cancer scr c- | $158 | $208 | -24% | 133 |
| 99487 Cplx chrnc care 1st 60 min | $94 | $121 | -22% | 125 |
| 71046 X-ray exam chest 2 views | $35 | $45 | -22% | 134 |
| 77049 Mri breast c-+ w/cad bi | $437 | $558 | -22% | 134 |
| 96574 Dbrdmt prmlg les w/pdt | $247 | $315 | -22% | 112 |
| 77065 Dx mammo incl cad uni | $141 | $179 | -21% | 133 |
| 77280 Ther rad simulaj field smpl | $239 | $302 | -21% | 112 |
| 71045 X-ray exam chest 1 view | $26 | $33 | -21% | 134 |
| 71275 Ct angiography chest | $366 | $462 | -21% | 134 |
| 77066 Dx mammo incl cad bi | $179 | $225 | -21% | 133 |
| 43248 Egd guide wire insertion | $289 | $364 | -21% | 124 |
| 15260 Fth/gft fr n/e/e/l 20 sqcm/< | $860 | $1,078 | -20% | 112 |
| 73502 X-ray exam hip uni 2-3 views | $49 | $61 | -20% | 258 |
| 76536 Us exam of head and neck | $124 | $154 | -20% | 133 |
Frequently asked questions
How do commercial reimbursement rates in Kentucky compare with the rest of the country?
Kentucky ranks 42nd of 51 states with an index of 88, across 228 procedure codes. Median commercial rates run 133% of the Medicare rate.
Which payer has the highest rates in Kentucky?
In the files we analyzed, UnitedHealthcare has the highest index (114) and Aetna the lowest (82). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Kentucky?
Cardiology ranks 31st of 51 states.
How many providers does this Kentucky page cover?
977 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Kentucky and the national median?
CPT 51720 (Treatment of bladder lesion) is highest relative to the nation at 106% of the national median; CPT 76641 (Ultrasound breast complete) is lowest at 75%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Kentucky contracts
Compare your negotiated rates with these state medians by payer and specialty.