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
StateIndex vs marketRank in statevs own nationalLevelProviders
Minnesota1332 of 4171
671
South Carolina1161 of 4105
311
Wisconsin1142 of 4192
733
Mississippi1121 of 4127
673
North Dakota1111 of 4148
329
Hawaii1091 of 4105
472
Florida1072 of 489
200
Idaho1072 of 4120
547
Nevada1052 of 494
277
Wyoming1031 of 4145
256
Maine1032 of 4103
215
Tennessee1032 of 4102
844
New Jersey1013 of 4100
787
Kansas1013 of 4102
749
Pennsylvania1012 of 497
564
Connecticut1003 of 4129
887
North Carolina1003 of 4100
976
Alaska1003 of 4243
290
Alabama1001 of 486
852
Colorado1002 of 4105
796
Michigan1003 of 494
846
South Dakota1003 of 4135
457
Montana1003 of 496
409
Indiana1003 of 485
912
New Hampshire1003 of 4128
692
Missouri1002 of 494
902
Utah992 of 497
667
Iowa993 of 4121
687
Washington983 of 4132
799
Georgia983 of 4122
944
Massachusetts983 of 4123
837
New York973 of 484
898
Oklahoma973 of 476
781
California963 of 490
807
Ohio952 of 494
893
Louisiana924 of 487
203
Oregon903 of 4124
351
Rhode Island903 of 487
581
Kentucky893 of 480
935
Vermont893 of 495
312
Texas884 of 469
1,003
Virginia874 of 478
813
Delaware873 of 482
170
Illinois864 of 483
841
Nebraska833 of 4119
574
Arizona824 of 466
479
Arkansas804 of 480
181
West Virginia783 of 474
292
New Mexico744 of 474
562
Maryland744 of 463
758
District of Columbia664 of 469
484

Blue Cross Blue Shield by specialty

Index vs the four-payer median for the specialty's codes
SpecialtyIndexRank of 4Highest onProviders
Dermatology1022 of 416%3,411
Ophthalmology1052 of 436%3,868
Orthopedic surgery1022 of 415%4,031
Gastroenterology1002 of 411%3,616
Cardiology993 of 48%4,056
Internal medicine1003 of 44%4,281
Urology973 of 43%3,444
Diagnostic radiology983 of 40%4,792

Where Blue Cross Blue Shield pays most and least against the market

Highest above market

CodeBCBSvs 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

CodeBCBSvs 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.

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