Blue Cross Blue Shield · California · commercial in-network
Blue Cross Blue Shield negotiated rates in California
How Blue Cross Blue Shield's California rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in California at a glance
Across 228 procedure codes for 8 specialties
Rate index vs state market
96
4% below the California median
Rank in state
3 of 4
UHC 126 · Cigna 112 · BCBS 96 · Aetna 84
vs own national
90
BCBS's level vs its national median
Codes where highest
6%
of 228 codes
What the data shows
Generated from California and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 3rd of 4 payers in California with a rate index of 96 (100 = the California market median), across 228 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 6% of codes in California; UnitedHealthcare leads with an index of 126 in the files analyzed.
3
Blue Cross Blue Shield's California rates sit 10% below its own national level, the 33rd highest of its 51 states.
4
Largest premium over the California market: CPT 97110 (Therapeutic exercises) at 152% of market; largest discount: CPT 76872 (Us transrectal) at 77%.
5
In California, BCBS rates come from 39 licensee file sets; the largest is Community Insurance Company (752 sampled providers).
How the four payers compare in California
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 126 | 1 | 58% | 658 | |
| Cigna | 112 | 2 | 34% | 648 | |
| Blue Cross Blue Shield | 96 | 3 | 6% | 807 | |
| Aetna | 84 | 4 | 2% | 566 |
Where Blue Cross Blue Shield pays most and least against the California market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 97110 Therapeutic exercises | $50 | $33 | +52% | 102 |
| 11102 Tangntl bx skin single les | $100 | $77 | +30% | 94 |
| 71046 X-ray exam chest 2 views | $54 | $43 | +28% | 100 |
| 96372 Ther/proph/diag inj sc/im | $34 | $27 | +24% | 90 |
| 64566 Neuroeltrd stim post tibial | $87 | $74 | +18% | 92 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $125 | $106 | +17% | 95 |
| 73502 X-ray exam hip uni 2-3 views | $71 | $61 | +17% | 201 |
| 71045 X-ray exam chest 1 view | $35 | $31 | +16% | 98 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 76872 Us transrectal | $141 | $183 | -23% | 95 |
| 92025 Cptrized corneal topography | $29 | $37 | -22% | 112 |
| 73721 Mri jnt of lwr extre w/o dye | $343 | $443 | -22% | 198 |
| 45390 Colonoscopy w/resection | $405 | $520 | -22% | 103 |
| 46221 Ligation of hemorrhoid(s) | $222 | $284 | -22% | 103 |
| 43242 Egd us fine needle bx/aspir | $342 | $429 | -20% | 103 |
| 77280 Ther rad simulaj field smpl | $201 | $249 | -20% | 95 |
| 93297 Rem interrog dev eval icpms | $28 | $35 | -19% | 105 |
Where Blue Cross Blue Shield pays above and below its national level
Index vs the payer's own national median (100 = national)
Highest states
| State | Index | Prov. | |
|---|---|---|---|
| Alaska | 243 | 290 | |
| Wisconsin | 192 | 733 | |
| Minnesota | 171 | 671 | |
| North Dakota | 148 | 329 | |
| Wyoming | 145 | 256 |
Lowest states
| State | Index | Prov. | |
|---|---|---|---|
| Maryland | 63 | 758 | |
| Arizona | 66 | 479 | |
| Texas | 69 | 1,003 | |
| District of Columbia | 69 | 484 | |
| New Mexico | 74 | 562 |
Blue Cross Blue Shield licensees in California
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| Community Insurance Company | 752 |
| Blue Shield of California Life & Health Insurance Company | 664 |
| BS CA | 656 |
| HealthKeepers, Inc. | 36 |
| Healthy Alliance Life Insurance Company | 21 |
| Matthew Thornton Health Plan, Inc. | 16 |
| Anthem (Elevance) | 15 |
| BCBS TX | 13 |
| BCBS MN | 10 |
| BCBS IL | 10 |
| BCBS MI | 7 |
| Wellmark | 7 |
| BCBS MA | 6 |
| BCBS NC | 6 |
| Carefirst BCBS | 6 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 6 |
| Regence | 5 |
| Compcare Health Services Insurance Corporation | 5 |
| BCBS NJ (Horizon) | 4 |
| Horizon Healthcare of New Jersey | 4 |
| Excellus BCBS | 4 |
| BCBS TN | 4 |
| Premera | 3 |
| BCBS RI | 3 |
| BCBS NM | 2 |
| BCBS OK | 2 |
| BCBS MT | 2 |
| BCBS AZ | 2 |
| Capital BlueCross | 2 |
| BCBS HI | 2 |
| Capital BC | 2 |
| Blue Cross Blue Shield of North Dakota | 1 |
| HMO Missouri, Inc. | 1 |
| HMO Colorado, Inc. | 1 |
| Blue Cross and Blue Shield of Massachusetts, Inc. | 1 |
| Blue Cross Blue Shield of Wyoming | 1 |
| BCBS MS | 1 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| BCBS KS | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in California?
Blue Cross Blue Shield ranks 3rd of 4 in California with an index of 96. It is highest on 6% of codes.
Are Blue Cross Blue Shield's California rates above or below its national level?
About 10% below.
Which procedure does Blue Cross Blue Shield pay most above market in California?
CPT 97110 (Therapeutic exercises), at 152% of the California median.
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 in California?
Compare your negotiated rates for these codes with California medians for each payer.