Tennessee · state market

Commercial healthcare reimbursement in Tennessee

How Tennessee compares with the nation, by payer, specialty and procedure.

State indexSnapshot Aug 2026

Tennessee at a glance

228 procedure codes, 8 specialties

Index vs national

4% below the national median

State rank

29 of 51

1 = highest

Median % of Medicare

143%

across tracked codes

Payers

944 sampled providers

What the data shows

Generated from this state's numbers

Tennessee ranks 29th of 51 states for commercial reimbursement, with an index of 96 (100 = national median) across 228 procedure codes; the South region averages 94.

Commercial rates in Tennessee run a median 143% of Medicare.

UnitedHealthcare has the highest index in the state (112) and Aetna the lowest (82), a 29-point gap, in the files analyzed.

CPT 71271 (Ct thorax lung cancer scr c-) is the strongest relative to the national median (119% of it, a 19% premium); CPT 88342 (Imhchem/imcytchm 1st antb) is furthest below (62% of the national median, 38% lower).

By specialty, Tennessee is strongest for orthopedic surgery (ranks 19th of 51 states for that specialty) and weakest for urology (38th of 50).

Against Medicare, gastroenterology has the highest ratio in Tennessee (197% of Medicare) and dermatology the lowest (90%).

Payer ranking in Tennessee

Index: 100 = the four-payer state median; counts are sampled providers and TINs

Payer	Index	Rank	Codes	Providers	TINs
UnitedHealthcare	112	1	228	775	476
Blue Cross Blue Shield	103	2	228	844	665
Cigna	97	3	228	850	573
Aetna	82	4	228	767	587

Reimbursement index by specialty in Tennessee

100 = the specialty's national median; the Medicare column compares median rates with the CY2026 Medicare rate

Specialty	Index	Rank among states	% of Medicare	Codes	Providers
Orthopedic surgery	109	19 of 51	147%	39	117
Diagnostic radiology	102	20 of 51	156%	49	131
Gastroenterology	103	21 of 50	197%	36	110
Cardiology	98	28 of 51	142%	38	123
Ophthalmology	93	32 of 50	112%	42	121
Dermatology	93	34 of 50	90%	44	123
Internal medicine	89	35 of 51	107%	25	109
Urology	91	38 of 50	143%	37	110

Specialty by payer in Tennessee

Index: 100 = the specialty's national median for the same codes; bold = highest payer for that specialty; n/a = fewer than 10 codes with enough data

Specialty	UHC	Aetna	Cigna	BCBS
Internal medicine	103	71	88	95
Dermatology	114	82	76	90
Ophthalmology	96	88	77	100
Cardiology	118	70	104	98
Orthopedic surgery	115	96	103	112
Diagnostic radiology	111	79	111	110
Urology	103	70	91	91
Gastroenterology	125	81	93	105

Tennessee compared with South region states

Closest states in the South region by index; the region averages 94

State	Index	Rank	% of Medicare	Providers
Tennessee	96	29	143%	944
West Virginia	93	34	146%	608
Arkansas	93	36	144%	788
South Carolina	92	38	140%	872
Virginia	91	39	139%	907
Louisiana	89	41	132%	917

Procedures that pay most and least in Tennessee vs the nation

Median across payers; the 15 largest gaps in each direction

Highest vs national

Code	Tennessee	National	Gap	Prov.
71271 Ct thorax lung cancer scr c-	$247	$208	+19%	127
72125 Ct neck spine w/o dye	$285	$249	+14%	128
72197 Mri pelvis w/o & w/dye	$725	$634	+14%	128
23472 Reconstruct shoulder joint	$2,650	$2,318	+14%	114
74183 Mri abd w/o cntr flwd cntr	$725	$634	+14%	128
27447 Total knee arthroplasty	$2,494	$2,190	+14%	114
27487 Revise/replace knee joint	$3,223	$2,840	+13%	114
27130 Total hip arthroplasty	$2,446	$2,158	+13%	115
22633 Arthrd cmbn 1ntrspc lumbar	$3,386	$2,991	+13%	114
72131 Ct lumbar spine w/o dye	$279	$248	+13%	128
70450 Ct head/brain w/o dye	$219	$194	+13%	128
27245 Treat thigh fracture	$2,243	$1,994	+12%	115
27236 Treat thigh fracture	$2,158	$1,918	+12%	114
22558 Arthrd ant ntrbd min dsc lum	$2,777	$2,471	+12%	114
29827 Sho arthrs srg rt8tr cuf rpr	$1,912	$1,701	+12%	115

Lowest vs national

Code	Tennessee	National	Gap	Prov.
88342 Imhchem/imcytchm 1st antb	$59	$95	-38%	123
88312 Special stains group 1	$64	$97	-34%	233
88305 Tissue exam by pathologist	$49	$70	-30%	233
76775 Us exam abdo back wall lim	$72	$92	-22%	109
88313 Special stains group 2	$55	$71	-22%	110
76857 Us exam pelvic limited	$60	$75	-20%	108
93297 Rem interrog dev eval icpms	$43	$52	-18%	123
76512 Oph us dx b-scan	$58	$70	-17%	119
92133 Cptrzd oph dx img pst sgm on	$35	$42	-17%	120
92235 Fluorescein angrph mltiframe	$122	$145	-16%	120
52332 Cystoscopy and treatment	$303	$360	-16%	108
92242 Fluorescein&icg angiography	$242	$288	-16%	119
96910 Photchmtx tar&uvb/ptrltm&uvb	$106	$125	-15%	122
76856 Us exam pelvic complete	$127	$148	-14%	109
77280 Ther rad simulaj field smpl	$260	$302	-14%	123

Frequently asked questions

Answers use this page's data

How do commercial reimbursement rates in Tennessee compare with the rest of the country?

Tennessee ranks 29th of 51 states with an index of 96, across 228 procedure codes. Median commercial rates run 143% of the Medicare rate.

Which payer has the highest rates in Tennessee?

In the files we analyzed, UnitedHealthcare has the highest index (112) 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 Tennessee?

Orthopedic surgery ranks 19th of 51 states.

How many providers does this Tennessee page cover?

944 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 Tennessee and the national median?

CPT 71271 (Ct thorax lung cancer scr c-) is highest relative to the nation at 119% of the national median; CPT 88342 (Imhchem/imcytchm 1st antb) is lowest at 62%.

Methodology

How these numbers are calculated

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.

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