Blue Cross Blue Shield · Iowa · commercial in-network

Blue Cross Blue Shield negotiated rates in Iowa

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

Blue Cross Blue Shield in Iowa at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
99
1% below the Iowa median
Rank in state
3 of 4
UHC 118 · Cigna 117 · BCBS 99 · Aetna 64
vs own national
121
BCBS's level vs its national median
Codes where highest
8%
of 228 codes
687 sampled providers440 TINs228 codesMedian 195% of Medicare · method

What the data shows

Generated from Iowa and Blue Cross Blue Shield data only
1

Blue Cross Blue Shield ranks 3rd of 4 payers in Iowa with a rate index of 99 (100 = the Iowa market median), across 228 procedure codes.

2

Blue Cross Blue Shield has the highest median for only 8% of codes in Iowa; UnitedHealthcare leads with an index of 118 in the files analyzed.

3

Blue Cross Blue Shield's Iowa rates sit 21% above its own national level, the 14th highest of its 51 states.

4

Largest premium over the Iowa market: CPT 93298 (Rem interrog dev eval scrms) at 194% of market; largest discount: CPT 99457 (Rpm tx mgmt 1st 20 min) at 66%.

5

In Iowa, BCBS rates come from 36 licensee file sets; the largest is Wellmark (638 sampled providers).

How the four payers compare in Iowa

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1181
118
47%605
Cigna1172
117
46%604
Blue Cross Blue Shield993
99
8%687
Aetna644
64
0%295

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

Codes with the largest gap to the state median

Highest above market

CodeBCBSMarketGapProv.
93298
Rem interrog dev eval scrms
$206$107+94%107
93297
Rem interrog dev eval icpms
$122$73+66%107
96910
Photchmtx tar&uvb/ptrltm&uvb
$199$169+18%62
93296
Rem interrog evl pm/ids
$63$59+8%107
72158
Mri lumbar spine w/o & w/dye
$742$692+7%93
74183
Mri abd w/o cntr flwd cntr
$784$732+7%93
72197
Mri pelvis w/o & w/dye
$780$729+7%93
70553
Mri brain stem w/o & w/dye
$739$691+7%93

Furthest below market

CodeBCBSMarketGapProv.
99457
Rpm tx mgmt 1st 20 min
$36$55-34%204
52648
Laser surgery of prostate
$1,056$1,518-30%81
92136
Ophthalmic biometry
$85$119-28%88
17313
Mohs 1 stage t/a/l
$511$693-26%62
11302
Shave skin lesion 1.1-2.0 cm
$96$130-26%62
17311
Mohs 1 stage h/n/hf/g
$570$771-26%62
92250
Fundus photography w/i&r
$66$89-26%90
11104
Punch bx skin single lesion
$76$102-26%62

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 Iowa

File sets contributing rates; licensees are different companies
Licensee file setSampled providers
Wellmark638
Healthy Alliance Life Insurance Company57
Community Insurance Company53
BCBS IL48
HealthKeepers, Inc.32
BCBS TX16
Blue Cross and Blue Shield of Nebraska16
BCBS MN12
Anthem (Elevance)11
BCBS KS7
Matthew Thornton Health Plan, Inc.7
BCBS Kansas City6
Blue Shield of California Life & Health Insurance Company5
BS CA5
BCBS NC5
Blue Cross Blue Shield of North Dakota4
BCBS MI4
Capital BC3
BCBS TN3
Blue Cross Blue Shield of Wyoming3
Capital BlueCross3
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.3
BCBS OK2
BCBS NJ (Horizon)2
HMO Colorado, Inc.2
Regence2
Horizon Healthcare of New Jersey2
Excellus BCBS2
BCBS MA1
Carefirst BCBS1
BCBS VT1
BCBS AZ1
BCBS AL1
Compcare Health Services Insurance Corporation1
Premera1
BCBS MT1

Frequently asked questions

Does Blue Cross Blue Shield pay more or less than the other payers in Iowa?

Blue Cross Blue Shield ranks 3rd of 4 in Iowa with an index of 99. It is highest on 8% of codes.

Are Blue Cross Blue Shield's Iowa rates above or below its national level?

About 21% above.

Which procedure does Blue Cross Blue Shield pay most above market in Iowa?

CPT 93298 (Rem interrog dev eval scrms), at 194% of the Iowa 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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