Corrected 2026-09-17, and the earlier correction was also wrong. An earlier version of this article reported 64 distinct prices for a blood test and about 1,500 for an office visit. Those counts were inflated 3.2–5.2× by our own method: we reduced each provider to one rate using an interpolating median, which on an even number of rates returns the midpoint of the two middle values — a number no contract contains. Minting one per provider inflates a count of distinct prices badly.
A correction notice published here on 2026-09-10 said the figures "should read 21 and 400." That notice was itself wrong. The re-derivation from the raw file gives 20 and 302. Both the original figures and the first correction are superseded by the table below, and readers who acted on the 2026-09-10 notice were told a number about a third too high for the office visit.
Every distinct-price count, concentration share, median rate and ×-Medicare figure below has been re-derived under the observed-rate estimator on the source file. One conclusion moved with them: established-patient office visits sit roughly a quarter below Medicare, not level with it. The finding this article is about — two pricing regimes an order of magnitude apart inside one contract — is unchanged and is better supported by the corrected numbers than by the wrong ones.
Open one insurer's public transparency file for a single metro and count something almost nobody counts: how many different in-network prices it publishes for the same billing code. Not the spread, not the average — the number of distinct rate values.
For a comprehensive metabolic panel — CPT 80053, one of the most ordinary blood tests in medicine — BlueCross BlueShield of Tennessee's in-network home-network file for the Nashville area lists 26 distinct prices across roughly 47,700 providers, and 44% of them are on the single most common rate. For a complete blood count (85025), it's 20 distinct prices, with 48% of providers sharing one rate to the penny.
Now look at a routine established-patient office visit in the same file — CPT 99214, the most-billed physician service in the country. It carries 302 distinct prices. The single most common rate covers about 8% of providers. A new-patient visit (99204) has 305.
Same insurer. Same city. Same file. Twenty prices for the blood test, three hundred for the office visit. That fifteen-fold gap is not a rounding difference — but it is worth saying plainly that an earlier version of this sentence claimed the same thing with the numbers 64 and fifteen hundred, and those were an artifact of our own estimator. The gap is real; the size we first published for it was not. It is two genuinely different pricing machines running inside one contract — and knowing which one you're in changes what you should do about your rates.
The number of prices is the tell
When an insurer publishes only a couple of dozen prices for a code and packs half the providers onto one of them, you are not looking at thousands of negotiations that happened to converge. You are looking at a fee schedule — a rate table the payer assigns providers onto. Unrelated practices don't independently negotiate their way to the identical penny; they get placed there.
When the same insurer publishes three hundred prices for a code and the most common one covers fewer than one provider in ten, the opposite is true. That is the footprint of individual negotiation — a long, dispersed tail where a provider's rate reflects who they are and what they agreed to, not a slot they were dropped into.
So the distinct-price count is a diagnostic. Few prices, high concentration → you were assigned. Many prices, low concentration → you negotiated (or failed to). And in this file the two regimes split cleanly along one line: commodity services are assigned; physician cognitive and procedural work is negotiated.
The commodity side: one price, take it
Labs are the purest case. Here is what the file pays and how tightly it's packed:
| Test | Distinct prices | % on the single most common rate | Top-5 concentration | Median rate |
|---|---|---|---|---|
| Complete blood count (85025) | 20 | 48% | 94% | $7.77 |
| Comprehensive metabolic panel (80053) | 26 | 44% | 87% | $6.15 |
Across the five most common rates, 87–94% of every provider on each test is accounted for. A blood test is a commodity — a machine runs it, the result is the result — and the insurer prices it like one: a short list of rates, nearly half of everyone on the same low number, measured in single dollars. There is nothing here to negotiate, and the file shows nobody really did.
Lab tests are paid under Medicare's separate Clinical Laboratory Fee Schedule, so they carry no Physician Fee Schedule multiple and are shown in absolute dollars only.
The negotiated side: three hundred prices, and a median below Medicare
Physician work behaves nothing like that. Office visits, physical therapy, and a common joint injection each carry two to four hundred distinct prices — more than ten times the labs — and the most common rate never covers even one provider in ten:
| Service | Distinct prices | % on top rate | Top-5 concentration | Median rate | Median vs Medicare | Vintage |
|---|---|---|---|---|---|---|
| Office visit, established L3 (99213) | 302 | 9.5% | 35% | $69.34 | 0.73× | 2026-07-27 |
| Office visit, established L4 (99214) | 302 | 8.2% | 34% | $99.98 | 0.74× | 2026-07-27 |
| Office visit, established L5 (99215) | 315 | 8.0% | 34% | $141.21 | 0.73× | 2026-08-27 |
| Office visit, new L4 (99204) | 305 | 9.6% | 35% | $160.23 | 0.90× | 2026-08-27 |
| Office visit, new L5 (99205) | 308 | 8.1% | 34% | $194.24 | 0.82× | 2026-08-27 |
| Physical therapy, ther. exercise (97110) | 192 | 8.9% | 36% | $29.20 | 1.00× | 2026-07-27 |
| Joint injection, major (20610) | 397 | 8.4% | 33% | $58.30 | 0.85× | 2026-07-27 |
Three rows carry the August vintage because those codes are not present in the July panel and the July raw file has since been withdrawn by the publisher, so their July values cannot be recovered by any re-run. For the codes present in both months the counts barely move — 85025 20→20, 99214 302→302, 99213 302→300, 97110 192→195, 20610 397→405 — which bounds what the substitution can cost.
Two things jump out. First, the dispersion is real: even where a round-number "list price" exists — $100.00 for a level-3 visit, $220.00 for a new-patient level-4 — fewer than one provider in ten is on it, and the top five rates together account for only about a third. This is a market of individual deals, not a schedule.
Second, and more important for a finance team: the typical negotiated rate lands about a quarter below Medicare. The median established-visit rate is 0.73–0.74× the Medicare fee. New-patient visits run higher (0.82–0.90×), and physical therapy sits right at parity (1.00×). After all those negotiations the middle of the market is below the government rate, not above it. The dispersion is wide, but it is centred under Medicare.
That is the one conclusion that changed when the figures were corrected. The earlier version of this section said the typical rate "lands right at Medicare" and quoted 0.84–0.85×; both the claim and those ratios came from the defective reduction.
The third machine: imaging, assigned and marked up
There's a service line that fits neither pattern cleanly, and it's the one we've written about before: imaging. Imaging in this same file isn't a single-price commodity like labs, and it isn't a dispersed negotiation like office visits. Its dominant rates are penny-identical schedules shared by thousands of providers, priced far above Medicare.
The scope here matters more than the multiple, and an earlier version of this article got it wrong by leaving it out. A named standard schedule held by 3,209 providers prices ten common imaging codes at a median of 3.27× Medicare; a higher schedule held by 775 providers runs at 3.77×. But those two schedules together are 8.6% of the 46,426-provider imaging panel. The median imaging provider is not on either of them. "Imaging is 3× Medicare" is true of that named ~3,200-provider schedule and false as a statement about imaging.
Put the three side by side and the contract stops looking like one negotiation and starts looking like three separate decisions the insurer made about where to spend and where to standardize:
- Labs — assigned, ~20–26 prices, priced at pennies.
- Physician visits, PT, injections — negotiated, ~200–400 prices, priced below Medicare.
- Imaging — large penny-identical schedules; the biggest of them sits at 3.27× Medicare, though it covers under 7% of imaging providers.
Your leverage and your markup are in different places
Here is the trap, and it's the whole reason to count prices instead of averaging them.
The services where you have negotiating leverage — office visits, the daily physician work that fills your schedule — are already priced below Medicare. There are three hundred prices, which means the door is open, but the room is nearly empty: the market has already settled under the government rate, so even a hard negotiation moves you a little.
The service with the real markup — the big imaging schedules — is the one you can't negotiate line by line, because it isn't a negotiation. It's a schedule assignment. You don't argue your MRI rate down; you get moved to a different tier, or you don't. Check first whether you are on one of those schedules at all, because most imaging providers in this file are not.
So the money and the leverage sit in different rooms. A provider org that pours its energy into haggling office-visit rates is negotiating hard in the one place the market has already flattened, while the schedule-assigned imaging line gets treated as fixed because "that's just the rate." It isn't a rate. It's a placement, and placements can be challenged, bundled, or steered around.
How to read your own contract
The practical move takes an afternoon and one public file:
- Count the distinct prices for each of your high-volume codes. A code with a couple of dozen prices and heavy concentration is a schedule you were assigned to — ask which tier you're on and what the next one pays, not whether your rate is "good." A code with hundreds of prices is a negotiation you're already inside — there your rate reflects your leverage, and the benchmark that matters is Medicare, because that's roughly where the middle of the market sits.
- Count providers, not just rates. A dramatic multiple on a schedule that covers 7% of a panel is a fact about that schedule, not about the service. We published this article without that check and had to correct it.
- Don't spend negotiation capital where the market is already flat. If your office-visit rates are near or below Medicare, so is nearly everyone's; there's a little to win, not a lot. Confirm it, then move on.
- Push hardest where you were assigned, not where you negotiated. The schedule-assigned, marked-up lines — imaging first — are where the gap between tiers is largest, and where "that's just the rate" is doing the most work to keep you from asking.
None of this needed inside information. It's one insurer's public file for one city, read against the public Medicare fee schedule, with the prices counted instead of blended. The single number that reorganizes the whole picture — how many different prices exist for one code — is sitting in the file, and almost nobody looks at it.
Methodology: rates are the negotiated in-network amounts for the CPT codes shown, drawn from BlueCross BlueShield of Tennessee's home-network machine-readable file for the Nashville area (series _890_, network S), parsed from the raw file after expanding its provider-reference groups to individual NPIs. Figures are the 2026-07-27 vintage except the three rows marked 2026-08-27. "Distinct prices" counts unique negotiated rate values for a code across all provider NPIs, each provider counted once at its observed representative rate — never an interpolated midpoint. That distinction is the correction this article carries: an interpolating median invents a rate per provider and inflated these counts by 3.2–5.2×. "% on top rate" is the share of provider NPIs carrying the single most frequent rate; "top-5 concentration" is the share on the five most frequent. "× Medicare" is the ratio to the 2026 national Medicare Physician Fee Schedule non-facility rate (total RVU × the 2026 conversion factor of $33.4009); laboratory tests are paid under the separate Clinical Laboratory Fee Schedule and carry no such multiple. Imaging figures are the global-component amounts for two named provider cohorts defined on anchor code 70450, with cohort sizes stated inline. Provider counts per code range from roughly 46,000 to 52,000 NPIs. No provider or customer names are used; every figure is reproducible from the source file and the published fee schedules.