Blue Cross Blue Shield negotiated rates in Massachusetts
How Blue Cross Blue Shield's Massachusetts rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Massachusetts at a glance
What the data shows
Blue Cross Blue Shield ranks 3rd of 4 payers in Massachusetts with a rate index of 98 (100 = the Massachusetts market median), across 228 procedure codes.
Blue Cross Blue Shield has the highest median for only 5% of codes in Massachusetts; UnitedHealthcare leads with an index of 137 in the files analyzed.
Blue Cross Blue Shield's Massachusetts rates sit 23% above its own national level, the 12th highest of its 51 states.
Largest premium over the Massachusetts market: CPT 88312 (Special stains group 1) at 179% of market; largest discount: CPT 76872 (Us transrectal) at 55%.
In Massachusetts, BCBS rates come from 34 licensee file sets; the largest is Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. (759 sampled providers).
How the four payers compare in Massachusetts
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 137 | 1 | 80% | 772 | |
| Cigna | 109 | 2 | 14% | 808 | |
| Blue Cross Blue Shield | 98 | 3 | 5% | 837 | |
| Aetna | 62 | 4 | 0% | 595 |
Where Blue Cross Blue Shield pays most and least against the Massachusetts market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 88312 Special stains group 1 | $238 | $133 | +79% | 131 |
| 88342 Imhchem/imcytchm 1st antb | $238 | $139 | +71% | 107 |
| 88305 Tissue exam by pathologist | $149 | $87 | +71% | 134 |
| 93298 Rem interrog dev eval scrms | $204 | $125 | +63% | 93 |
| 88313 Special stains group 2 | $131 | $86 | +53% | 22 |
| 92235 Fluorescein angrph mltiframe | $290 | $198 | +47% | 105 |
| 92242 Fluorescein&icg angiography | $603 | $416 | +45% | 105 |
| 74178 Ct abd&plv wo cntr flwd cntr | $723 | $520 | +39% | 86 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 76872 Us transrectal | $142 | $258 | -45% | 29 |
| 92004 Compre oph exam new pt 1/> | $107 | $177 | -40% | 105 |
| 92014 Compre oph exam est pt 1/> | $95 | $148 | -36% | 105 |
| 51700 Irrigation of bladder | $58 | $83 | -30% | 102 |
| 51702 Insert temp bladder cath | $48 | $66 | -26% | 102 |
| 52000 Cystourethroscopy | $156 | $208 | -25% | 103 |
| 51720 Treatment of bladder lesion | $85 | $113 | -25% | 100 |
| 76856 Us exam pelvic complete | $117 | $154 | -24% | 30 |
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 Massachusetts
| Licensee file set | Sampled providers |
|---|---|
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 759 |
| BCBS MA | 604 |
| Compcare Health Services Insurance Corporation | 108 |
| Community Insurance Company | 91 |
| HealthKeepers, Inc. | 53 |
| Anthem (Elevance) | 45 |
| Blue Cross and Blue Shield of Massachusetts, Inc. | 43 |
| BCBS RI | 34 |
| Matthew Thornton Health Plan, Inc. | 22 |
| Healthy Alliance Life Insurance Company | 16 |
| BCBS TX | 12 |
| Carefirst BCBS | 9 |
| BCBS MN | 8 |
| BCBS IL | 8 |
| BCBS NC | 7 |
| Excellus BCBS | 5 |
| BS CA | 5 |
| Blue Shield of California Life & Health Insurance Company | 5 |
| Capital BlueCross | 4 |
| BCBS NM | 4 |
| Capital BC | 4 |
| Horizon Healthcare of New Jersey | 4 |
| BCBS NJ (Horizon) | 4 |
| HMO Colorado, Inc. | 3 |
| BCBS VT | 3 |
| Blue Cross Blue Shield of North Dakota | 2 |
| BCBS AZ | 2 |
| Regence | 2 |
| BCBS KS | 2 |
| Wellmark | 2 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| BCBS Kansas City | 1 |
| Blue Cross Blue Shield of Wyoming | 1 |
| Premera | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Massachusetts?
Blue Cross Blue Shield ranks 3rd of 4 in Massachusetts with an index of 98. It is highest on 5% of codes.
Are Blue Cross Blue Shield's Massachusetts rates above or below its national level?
About 23% above.
Which procedure does Blue Cross Blue Shield pay most above market in Massachusetts?
CPT 88312 (Special stains group 1), at 179% of the Massachusetts 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 Massachusetts?
Compare your negotiated rates for these codes with Massachusetts medians for each payer.