A CT scan of the head, without contrast — CPT 70450 — is one of the most standardized procedures in medicine. Same machine class, same protocol, same read.
In the Nashville metro area, BlueCross BlueShield of Tennessee pays some providers a median of $54 for it. It pays others $333.
That's a 6.2x spread, inside one insurer's network, inside one city, for the same procedure. We found it by extracting the plan's federally mandated price file — the one every commercial insurer has been required to publish since 2022 — and computing provider-level median rates for 365 imaging providers across ten common imaging codes.
Then we noticed something stranger than the spread.
The spread is identical on nine of ten codes
| CPT | Procedure | Lowest provider median | Market median | Highest provider median | Spread |
|---|---|---|---|---|---|
| 70450 | CT head/brain, w/o contrast | $54 | $179 | $333 | 6.2x |
| 70553 | MRI brain | $180 | $652 | $1,120 | 6.2x |
| 71260 | CT thorax | $92 | $297 | $571 | 6.2x |
| 72110 | X-ray, lumbosacral spine | $28 | $83 | $173 | 6.2x |
| 72148 | MRI lumbar spine | $104 | $387 | $643 | 6.2x |
| 73721 | MRI joint, lower extremity | $117 | $410 | $723 | 6.2x |
| 74177 | CT abdomen & pelvis | $180 | $542 | $1,118 | 6.2x |
| 76700 | Ultrasound, abdominal | $61 | $197 | $380 | 6.2x |
| 76856 | Ultrasound, pelvic | $56 | $182 | $350 | 6.2x |
| 77067 | Screening mammography | $70 | $185 | $276 | 4.0x |
Provider-level median professional-component rates, 365 Nashville-MSA imaging providers, BCBS-TN home-network file published 2026-06-27. Negotiated rates are contracted amounts; actual payment can vary with plan terms.
Nine unrelated procedures — CT, MRI, X-ray, ultrasound — and the ratio between the best-paid and worst-paid provider is 6.2x on every single one.
That uniformity is not a coincidence, and it's the most useful fact in the file. If the spread were driven by procedure-level dynamics — equipment costs, volume discounts on specific scans — it would vary by code. It doesn't. The pattern is consistent with something simpler: each provider's contract sets one multiplier, and that multiplier is applied across the entire fee schedule.
In other words: the payer isn't pricing your CT scans. It's pricing you.
(The one exception, screening mammography at 4.0x, is the kind of exception that supports the rule — screening mammograms sit under distinct benefit-design and pricing pressure than diagnostic imaging.)
What this means if you run provider finances
Three things fall out of this pattern, and none of them are visible from your own contract alone.
1. You have a number, not a rate sheet. If your organization's rates are set by one multiplier, then the negotiation that matters is not about any individual code — it's about where your multiplier sits in the distribution. A provider at the bottom of this market isn't underpaid on CT scans; they're underpaid on everything, by the same factor.
2. The distribution is knowable. The payer has always known exactly where you sit — that's their side of the table. Since 2022, the same information has been sitting in their published files. The file we analyzed is public. Reading it took engineering; that's the part we built.
3. "Market rate" claims are now checkable. When a payer rep says an offer is competitive for your market, that's a claim about a distribution — the one in the table above. Half the providers in this market are being paid below $179 for a head CT while the top of the same network is at $333. "Competitive" is doing a lot of work in that sentence.
One honest caveat
These are professional-component rates — the physician-work portion — because that's what this plan's home-network file predominantly prices for imaging. Facility fees follow their own structures. And a negotiated rate is a contracted amount, not a guarantee of what any specific claim pays. What the file gives you is the shape of the market and your position in it — which is precisely the thing you can't get from your own contract.
See your own multiplier
If you want to know where your organization sits in your payer's distribution, that's the exact question our Gap Check answers: send us your fee schedule, and we'll show you the gap — what you're paid, what the same payer pays comparable providers in your market, and what you could be making. No sales call required to find out.
Methodology: DeductibleData extracted all professional-component negotiated rates for ten imaging CPTs from the BCBS of Tennessee home-network MRF series published 2026-06-27, filtered to 365 Nashville-MSA imaging providers (45,678 rate rows). Per-provider medians are computed across plan variants to avoid conflating plan-design differences with provider-level rate position. Provider identities are not disclosed. Data available under the Transparency in Coverage Rule.