Blue Cross Blue Shield · District of Columbia · commercial in-network

Blue Cross Blue Shield negotiated rates in District of Columbia

How Blue Cross Blue Shield's District of Columbia rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.

Blue Cross Blue Shield in District of Columbia at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
66
34% below the District of Columbia median
Rank in state
4 of 4
UHC 142 · Cigna 121 · Aetna 102 · BCBS 66
vs own national
69
BCBS's level vs its national median
Codes where highest
1%
of 228 codes
484 sampled providers443 TINs228 codesMedian 106% of Medicare · method

What the data shows

Generated from District of Columbia and Blue Cross Blue Shield data only
1

Blue Cross Blue Shield ranks 4th of 4 payers in District of Columbia with a rate index of 66 (100 = the District of Columbia market median), across 228 procedure codes.

2

Blue Cross Blue Shield has the highest median for only 1% of codes in District of Columbia; UnitedHealthcare leads with an index of 142 in the files analyzed.

3

Blue Cross Blue Shield's District of Columbia rates sit 31% below its own national level, the 48th highest of its 51 states.

4

Largest premium over the District of Columbia market: CPT 88342 (Imhchem/imcytchm 1st antb) at 125% of market; largest discount: CPT 77280 (Ther rad simulaj field smpl) at 15%.

5

In District of Columbia, BCBS rates come from 36 licensee file sets; the largest is Carefirst BCBS (390 sampled providers).

How the four payers compare in District of Columbia

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1421
142
59%396
Cigna1212
121
19%430
Aetna1023
102
21%357
Blue Cross Blue Shield664
66
1%484

Where Blue Cross Blue Shield pays most and least against the District of Columbia market

Codes with the largest gap to the state median

Highest above market

CodeBCBSMarketGapProv.
88342
Imhchem/imcytchm 1st antb
$103$82+25%31
14040
Tis trnfr f/c/c/m/n/a/g/h/f
$759$701+8%31
15260
Fth/gft fr n/e/e/l 20 sqcm/<
$1,027$949+8%31
14061
Tis trnfr e/n/e/l10.1-30sqcm
$993$921+8%31
17000
Destruct premalg lesion
$64$60+7%30
14041
Tis trnfr f/c/c/m/n/a/g/h/f
$925$878+5%31
13121
Cmplx rpr s/a/l 2.6-7.5 cm
$311$311+0%31
92235
Fluorescein angrph mltiframe
$145$145+0%48

Furthest below market

CodeBCBSMarketGapProv.
77280
Ther rad simulaj field smpl
$36$246-85%31
92242
Fluorescein&icg angiography
$47$247-81%48
77066
Dx mammo incl cad bi
$45$203-78%121
71046
X-ray exam chest 2 views
$10$40-75%121
77049
Mri breast c-+ w/cad bi
$135$500-73%121
73610
X-ray exam of ankle
$16$57-72%34
93298
Rem interrog dev eval scrms
$19$59-68%75
93312
Echo transesophageal
$149$440-66%74

Where Blue Cross Blue Shield pays above and below its national level

Index vs the payer's own national median (100 = national)

Highest states

StateIndexProv.
Alaska243
290
Wisconsin192
733
Minnesota171
671
North Dakota148
329
Wyoming145
256

Lowest states

StateIndexProv.
Maryland63
758
Arizona66
479
Texas69
1,003
District of Columbia69
484
New Mexico74
562

Blue Cross Blue Shield licensees in District of Columbia

File sets contributing rates; licensees are different companies
Licensee file setSampled providers
Carefirst BCBS390
Community Insurance Company313
HealthKeepers, Inc.24
Healthy Alliance Life Insurance Company19
BCBS TX17
BCBS NC16
BCBS IL13
Anthem (Elevance)11
Blue Shield of California Life & Health Insurance Company9
BS CA9
Horizon Healthcare of New Jersey8
BCBS MI8
BCBS NJ (Horizon)8
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.6
BCBS MA5
BCBS KS5
Compcare Health Services Insurance Corporation5
BCBS HI5
Blue Cross Blue Shield of North Dakota4
Matthew Thornton Health Plan, Inc.4
Excellus BCBS3
BCBS RI3
Wellmark2
BCBS VT2
BCBS OK2
Blue Cross Blue Shield of Wyoming2
BCBS Kansas City1
BCBS MT1
Blue Cross and Blue Shield of Nebraska1
BCBS AL1
Regence1
Capital BC1
Capital BlueCross1
Premera1
BCBS TN1
HMO Colorado, Inc.1

Frequently asked questions

Does Blue Cross Blue Shield pay more or less than the other payers in District of Columbia?

Blue Cross Blue Shield ranks 4th of 4 in District of Columbia with an index of 66. It is highest on 1% of codes.

Are Blue Cross Blue Shield&#39;s District of Columbia rates above or below its national level?

About 31% below.

Which procedure does Blue Cross Blue Shield pay most above market in District of Columbia?

CPT 88342 (Imhchem/imcytchm 1st antb), at 125% of the District of Columbia 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.

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