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
What the data shows
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.
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.
Blue Cross Blue Shield's Iowa rates sit 21% above its own national level, the 14th highest of its 51 states.
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%.
In Iowa, BCBS rates come from 36 licensee file sets; the largest is Wellmark (638 sampled providers).
How the four payers compare in Iowa
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 118 | 1 | 47% | 605 | |
| Cigna | 117 | 2 | 46% | 604 | |
| Blue Cross Blue Shield | 99 | 3 | 8% | 687 | |
| Aetna | 64 | 4 | 0% | 295 |
Where Blue Cross Blue Shield pays most and least against the Iowa market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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 Iowa
| Licensee file set | Sampled providers |
|---|---|
| Wellmark | 638 |
| Healthy Alliance Life Insurance Company | 57 |
| Community Insurance Company | 53 |
| BCBS IL | 48 |
| HealthKeepers, Inc. | 32 |
| BCBS TX | 16 |
| Blue Cross and Blue Shield of Nebraska | 16 |
| BCBS MN | 12 |
| Anthem (Elevance) | 11 |
| BCBS KS | 7 |
| Matthew Thornton Health Plan, Inc. | 7 |
| BCBS Kansas City | 6 |
| Blue Shield of California Life & Health Insurance Company | 5 |
| BS CA | 5 |
| BCBS NC | 5 |
| Blue Cross Blue Shield of North Dakota | 4 |
| BCBS MI | 4 |
| Capital BC | 3 |
| BCBS TN | 3 |
| Blue Cross Blue Shield of Wyoming | 3 |
| Capital BlueCross | 3 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 3 |
| BCBS OK | 2 |
| BCBS NJ (Horizon) | 2 |
| HMO Colorado, Inc. | 2 |
| Regence | 2 |
| Horizon Healthcare of New Jersey | 2 |
| Excellus BCBS | 2 |
| BCBS MA | 1 |
| Carefirst BCBS | 1 |
| BCBS VT | 1 |
| BCBS AZ | 1 |
| BCBS AL | 1 |
| Compcare Health Services Insurance Corporation | 1 |
| Premera | 1 |
| BCBS MT | 1 |
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
- 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 Iowa?
Compare your negotiated rates for these codes with Iowa medians for each payer.