Blue Cross Blue Shield · Illinois · commercial in-network
Blue Cross Blue Shield negotiated rates in Illinois
How Blue Cross Blue Shield's Illinois rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Illinois at a glance
Across 228 procedure codes for 8 specialties
Rate index vs state market
86
14% below the Illinois median
Rank in state
4 of 4
UHC 133 · Cigna 106 · Aetna 88 · BCBS 86
vs own national
83
BCBS's level vs its national median
Codes where highest
5%
of 228 codes
What the data shows
Generated from Illinois and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 4th of 4 payers in Illinois with a rate index of 86 (100 = the Illinois market median), across 228 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 5% of codes in Illinois; UnitedHealthcare leads with an index of 133 in the files analyzed.
3
Blue Cross Blue Shield's Illinois rates sit 17% below its own national level, the 40th highest of its 51 states.
4
Largest premium over the Illinois market: CPT 51798 (Us urine capacity measure) at 137% of market; largest discount: CPT 93925 (Lower extremity study) at 22%.
5
In Illinois, BCBS rates come from 36 licensee file sets; the largest is BCBS IL (789 sampled providers).
How the four payers compare in Illinois
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 133 | 1 | 86% | 706 | |
| Cigna | 106 | 2 | 8% | 644 | |
| Aetna | 88 | 3 | 1% | 626 | |
| Blue Cross Blue Shield | 86 | 4 | 5% | 841 |
Where Blue Cross Blue Shield pays most and least against the Illinois market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 51798 Us urine capacity measure | $31 | $23 | +37% | 102 |
| 36482 Endoven ther chem adhes 1st | $376 | $337 | +12% | 108 |
| 96372 Ther/proph/diag inj sc/im | $28 | $26 | +11% | 86 |
| 96413 Chemo iv infusion 1 hr | $261 | $238 | +10% | 111 |
| 96574 Dbrdmt prmlg les w/pdt | $394 | $364 | +8% | 110 |
| 37243 Vasc embolize/occlude organ | $1,060 | $991 | +7% | 115 |
| 65820 Goniotomy | $1,227 | $1,164 | +6% | 101 |
| 65756 Corneal trnspl endothelial | $1,709 | $1,634 | +5% | 100 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93925 Lower extremity study | $71 | $329 | -78% | 110 |
| 91110 Gi trc img intral esoph-ile | $241 | $1,059 | -77% | 110 |
| 78452 Ht muscle image spect mult | $142 | $573 | -75% | 186 |
| 93970 Extremity study | $62 | $247 | -75% | 226 |
| 92242 Fluorescein&icg angiography | $69 | $254 | -73% | 99 |
| 93880 Extracranial bilat study | $72 | $251 | -71% | 306 |
| 88313 Special stains group 2 | $21 | $70 | -70% | 111 |
| 77280 Ther rad simulaj field smpl | $80 | $266 | -70% | 110 |
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 Illinois
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| BCBS IL | 789 |
| Community Insurance Company | 120 |
| HealthKeepers, Inc. | 78 |
| Matthew Thornton Health Plan, Inc. | 50 |
| Healthy Alliance Life Insurance Company | 43 |
| Anthem (Elevance) | 41 |
| BCBS TX | 22 |
| Wellmark | 19 |
| BCBS MI | 18 |
| BS CA | 13 |
| Blue Shield of California Life & Health Insurance Company | 13 |
| BCBS MN | 9 |
| BCBS TN | 7 |
| BCBS NC | 6 |
| Compcare Health Services Insurance Corporation | 6 |
| Carefirst BCBS | 5 |
| Blue Cross Blue Shield of North Dakota | 4 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 4 |
| BCBS MA | 4 |
| Horizon Healthcare of New Jersey | 3 |
| BCBS NJ (Horizon) | 3 |
| Excellus BCBS | 3 |
| BCBS AZ | 3 |
| BCBS NM | 3 |
| BCBS KS | 3 |
| Premera | 3 |
| BCBS MT | 2 |
| BCBS MS | 2 |
| Blue Cross Blue Shield of Wyoming | 2 |
| BCBS HI | 2 |
| BCBS OK | 2 |
| Regence | 1 |
| BCBS AL | 1 |
| Capital BlueCross | 1 |
| HMO Colorado, Inc. | 1 |
| Capital BC | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Illinois?
Blue Cross Blue Shield ranks 4th of 4 in Illinois with an index of 86. It is highest on 5% of codes.
Are Blue Cross Blue Shield's Illinois rates above or below its national level?
About 17% below.
Which procedure does Blue Cross Blue Shield pay most above market in Illinois?
CPT 51798 (Us urine capacity measure), at 137% of the Illinois 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 Illinois?
Compare your negotiated rates for these codes with Illinois medians for each payer.