This service covers the first hour, per month, of behind-the-scenes care coordination for a person with multiple serious, ongoing health conditions. Clinical staff spend this time each month organizing care between different providers, managing medications, and addressing complex needs that require significant medical decision-making, typically without the patient being present. It reflects a higher level of coordination than routine chronic condition management.
Rates data updated October 2026.
How much does Complex Chronic Care Management, First Hour cost?
$85.11
Typical physician fee. In Tennessee, October 2026.
Insurers have agreed to pay about $85.11 for this service. Most negotiated rates run $67.61 to $120.
These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.
How much rates vary
Facilitymedian $39 · 10th to 90th $39 to $68Professionalmedian $85 · 10th to 90th $44 to $129
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Facility
Modifier
None
Typical Low
$38.90
Median
$38.90
Typical High
$67.61
Facility
None
$38.90
$38.90
$67.61
Aetna
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$67.61
Typical High
$89.13
Professional
None
$38.90
$67.61
$89.13
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$19.50
Median
$33.88
Typical High
$44.67
Professional
52 · Reduced service
$19.50
$33.88
$44.67
Ambetter
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$141.25
Professional
None
$134.90
$134.90
$141.25
BCBS Tennessee
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$104.71
Typical High
$120.23
Professional
None
$85.11
$104.71
$120.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$100.00
Typical High
$151.36
Professional
None
$67.61
$100.00
$151.36
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Professional
None
$831.76
$831.76
$831.76
United
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$83.18
Typical High
$138.04
Professional
None
$48.98
$83.18
$138.04
1 more rate with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Ambetter
Setting
Professional
Modifier
SA · Nurse practitioner
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Professional
SA · Nurse practitioner
$114.82
$114.82
$114.82
Where Tennessee sits
The same service costs 3.4 times more in Alaska than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.