Blue Cross Blue Shield · payer overview
Blue Cross Blue Shield negotiated rates by state and specialty
Where Blue Cross Blue Shield pays above and below the market, from its published in-network files.
Blue Cross Blue Shield at a glance
228 codes · 51 states · 31,499 sampled providers · source: BCBS licensees' own-network files
Rate index
100
100 = four-payer median
Payer rank
3 of 4
1 = highest
Median % of Medicare
148%
across tracked codes
Highest on
13%
of codes
What the data shows
1
Blue Cross Blue Shield ranks 3rd of 4 payers with a rate index of 100 (100 = four-payer median) across 228 procedure codes.
2
Its median rate is 148% of Medicare, and it has the highest median on 13% of codes in the files analyzed.
3
Strongest market: Minnesota (index 133 vs that state's market); weakest: District of Columbia (66).
4
Largest premium over the market: CPT 93298 (Rem interrog dev eval scrms) at 190% of market.
5
By specialty it is strongest for dermatology (ranks 2nd of 4 payers).
Blue Cross Blue Shield by state
Index vs the state market; own-national index vs the payer's national level
| State | Index vs market | Rank in state | vs own national | Level | Providers |
|---|---|---|---|---|---|
| Minnesota | 133 | 2 of 4 | 171 | 671 | |
| South Carolina | 116 | 1 of 4 | 105 | 311 | |
| Wisconsin | 114 | 2 of 4 | 192 | 733 | |
| Mississippi | 112 | 1 of 4 | 127 | 673 | |
| North Dakota | 111 | 1 of 4 | 148 | 329 | |
| Hawaii | 109 | 1 of 4 | 105 | 472 | |
| Florida | 107 | 2 of 4 | 89 | 200 | |
| Idaho | 107 | 2 of 4 | 120 | 547 | |
| Nevada | 105 | 2 of 4 | 94 | 277 | |
| Wyoming | 103 | 1 of 4 | 145 | 256 | |
| Maine | 103 | 2 of 4 | 103 | 215 | |
| Tennessee | 103 | 2 of 4 | 102 | 844 | |
| New Jersey | 101 | 3 of 4 | 100 | 787 | |
| Kansas | 101 | 3 of 4 | 102 | 749 | |
| Pennsylvania | 101 | 2 of 4 | 97 | 564 | |
| Connecticut | 100 | 3 of 4 | 129 | 887 | |
| North Carolina | 100 | 3 of 4 | 100 | 976 | |
| Alaska | 100 | 3 of 4 | 243 | 290 | |
| Alabama | 100 | 1 of 4 | 86 | 852 | |
| Colorado | 100 | 2 of 4 | 105 | 796 | |
| Michigan | 100 | 3 of 4 | 94 | 846 | |
| South Dakota | 100 | 3 of 4 | 135 | 457 | |
| Montana | 100 | 3 of 4 | 96 | 409 | |
| Indiana | 100 | 3 of 4 | 85 | 912 | |
| New Hampshire | 100 | 3 of 4 | 128 | 692 | |
| Missouri | 100 | 2 of 4 | 94 | 902 | |
| Utah | 99 | 2 of 4 | 97 | 667 | |
| Iowa | 99 | 3 of 4 | 121 | 687 | |
| Washington | 98 | 3 of 4 | 132 | 799 | |
| Georgia | 98 | 3 of 4 | 122 | 944 | |
| Massachusetts | 98 | 3 of 4 | 123 | 837 | |
| New York | 97 | 3 of 4 | 84 | 898 | |
| Oklahoma | 97 | 3 of 4 | 76 | 781 | |
| California | 96 | 3 of 4 | 90 | 807 | |
| Ohio | 95 | 2 of 4 | 94 | 893 | |
| Louisiana | 92 | 4 of 4 | 87 | 203 | |
| Oregon | 90 | 3 of 4 | 124 | 351 | |
| Rhode Island | 90 | 3 of 4 | 87 | 581 | |
| Kentucky | 89 | 3 of 4 | 80 | 935 | |
| Vermont | 89 | 3 of 4 | 95 | 312 | |
| Texas | 88 | 4 of 4 | 69 | 1,003 | |
| Virginia | 87 | 4 of 4 | 78 | 813 | |
| Delaware | 87 | 3 of 4 | 82 | 170 | |
| Illinois | 86 | 4 of 4 | 83 | 841 | |
| Nebraska | 83 | 3 of 4 | 119 | 574 | |
| Arizona | 82 | 4 of 4 | 66 | 479 | |
| Arkansas | 80 | 4 of 4 | 80 | 181 | |
| West Virginia | 78 | 3 of 4 | 74 | 292 | |
| New Mexico | 74 | 4 of 4 | 74 | 562 | |
| Maryland | 74 | 4 of 4 | 63 | 758 | |
| District of Columbia | 66 | 4 of 4 | 69 | 484 |
Blue Cross Blue Shield by specialty
Index vs the four-payer median for the specialty's codes
| Specialty | Index | Rank of 4 | Highest on | Providers |
|---|---|---|---|---|
| Dermatology | 102 | 2 of 4 | 16% | 3,411 |
| Ophthalmology | 105 | 2 of 4 | 36% | 3,868 |
| Orthopedic surgery | 102 | 2 of 4 | 15% | 4,031 |
| Gastroenterology | 100 | 2 of 4 | 11% | 3,616 |
| Cardiology | 99 | 3 of 4 | 8% | 4,056 |
| Internal medicine | 100 | 3 of 4 | 4% | 4,281 |
| Urology | 97 | 3 of 4 | 3% | 3,444 |
| Diagnostic radiology | 98 | 3 of 4 | 0% | 4,792 |
Where Blue Cross Blue Shield pays most and least against the market
Highest above market
| Code | BCBS | vs market |
|---|---|---|
| 93298 Rem interrog dev eval scrms | $100 | +90% |
| 88305 Tissue exam by pathologist | $93 | +33% |
| 88313 Special stains group 2 | $86 | +22% |
| 93297 Rem interrog dev eval icpms | $62 | +19% |
| 92235 Fluorescein angrph mltiframe | $170 | +17% |
| 88312 Special stains group 1 | $112 | +15% |
| 88342 Imhchem/imcytchm 1st antb | $109 | +14% |
| 67028 Injection eye drug | $154 | +12% |
Furthest below market
| Code | BCBS | vs market |
|---|---|---|
| 64566 Neuroeltrd stim post tibial | $56 | -19% |
| 92004 Compre oph exam new pt 1/> | $106 | -14% |
| 52648 Laser surgery of prostate | $1,295 | -14% |
| 51700 Irrigation of bladder | $66 | -14% |
| 99426 Prin care mgmt staff 1st 30 | $66 | -14% |
| 52000 Cystourethroscopy | $182 | -14% |
| 51720 Treatment of bladder lesion | $96 | -13% |
| 93925 Lower extremity study | $310 | -11% |
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.
Is your Blue Cross Blue Shield contract at market?
Compare your negotiated rates with these medians by state and specialty.