Blue Cross Blue Shield · Missouri · commercial in-network
Blue Cross Blue Shield negotiated rates in Missouri
How Blue Cross Blue Shield's Missouri rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Missouri at a glance
Across 228 procedure codes for 8 specialties
Rate index vs state market
100
0% below the Missouri median
Rank in state
2 of 4
UHC 112 · BCBS 100 · Cigna 96 · Aetna 82
vs own national
94
BCBS's level vs its national median
Codes where highest
20%
of 228 codes
What the data shows
Generated from Missouri and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 2nd of 4 payers in Missouri with a rate index of 100 (100 = the Missouri market median), across 228 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 20% of codes in Missouri; UnitedHealthcare leads with an index of 112 in the files analyzed.
3
Blue Cross Blue Shield's Missouri rates sit 6% below its own national level, the 32nd highest of its 51 states.
4
Largest premium over the Missouri market: CPT 88305 (Tissue exam by pathologist) at 145% of market; largest discount: CPT 96910 (Photchmtx tar&uvb/ptrltm&uvb) at 73%.
5
In Missouri, BCBS rates come from 39 licensee file sets; the largest is Community Insurance Company (702 sampled providers).
How the four payers compare in Missouri
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 112 | 1 | 67% | 821 | |
| Blue Cross Blue Shield | 100 | 2 | 20% | 902 | |
| Cigna | 96 | 3 | 7% | 849 | |
| Aetna | 82 | 4 | 6% | 630 |
Where Blue Cross Blue Shield pays most and least against the Missouri market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 88305 Tissue exam by pathologist | $99 | $68 | +45% | 240 |
| 88313 Special stains group 2 | $99 | $71 | +40% | 126 |
| 67028 Injection eye drug | $165 | $119 | +38% | 99 |
| 92136 Ophthalmic biometry | $86 | $66 | +31% | 98 |
| 67210 Treatment of retinal lesion | $733 | $582 | +26% | 99 |
| 67108 Repair detached retina | $1,737 | $1,405 | +24% | 99 |
| 88312 Special stains group 1 | $114 | $94 | +22% | 240 |
| 66984 Xcapsl ctrc rmvl w/o ecp | $864 | $713 | +21% | 99 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $86 | $118 | -27% | 114 |
| 64566 Neuroeltrd stim post tibial | $43 | $58 | -26% | 114 |
| 99495 Transj care mgmt mod f2f 14d | $139 | $186 | -25% | 108 |
| 51729 Cystometrogram w/vp&up | $410 | $546 | -25% | 113 |
| 51728 Cystometrogram w/vp | $389 | $516 | -25% | 113 |
| 26055 Incise finger tendon sheath | $396 | $508 | -22% | 104 |
| 77067 Scr mammo bi incl cad | $145 | $184 | -21% | 116 |
| 99487 Cplx chrnc care 1st 60 min | $83 | $106 | -21% | 108 |
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 Missouri
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| Community Insurance Company | 702 |
| HealthKeepers, Inc. | 669 |
| Matthew Thornton Health Plan, Inc. | 666 |
| BCBS Kansas City | 151 |
| BCBS KS | 95 |
| BCBS IL | 88 |
| Healthy Alliance Life Insurance Company | 30 |
| BCBS TX | 27 |
| Anthem (Elevance) | 23 |
| Wellmark | 13 |
| Blue Shield of California Life & Health Insurance Company | 12 |
| BS CA | 12 |
| BCBS TN | 12 |
| BCBS NC | 10 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 8 |
| BCBS MA | 7 |
| BCBS MN | 7 |
| BCBS MI | 6 |
| Compcare Health Services Insurance Corporation | 6 |
| Regence | 5 |
| Carefirst BCBS | 5 |
| BCBS RI | 5 |
| BCBS OK | 4 |
| HMO Colorado, Inc. | 4 |
| Excellus BCBS | 4 |
| BCBS HI | 3 |
| Capital BC | 3 |
| Premera | 3 |
| Capital BlueCross | 3 |
| Blue Cross and Blue Shield of Nebraska | 3 |
| BCBS NM | 2 |
| Blue Cross Blue Shield of North Dakota | 2 |
| BCBS MT | 2 |
| BCBS AL | 2 |
| Horizon Healthcare of New Jersey | 1 |
| BCBS NJ (Horizon) | 1 |
| HMO Missouri, Inc. | 1 |
| BCBS MS | 1 |
| BCBS AZ | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Missouri?
Blue Cross Blue Shield ranks 2nd of 4 in Missouri with an index of 100. It is highest on 20% of codes.
Are Blue Cross Blue Shield's Missouri rates above or below its national level?
About 6% below.
Which procedure does Blue Cross Blue Shield pay most above market in Missouri?
CPT 88305 (Tissue exam by pathologist), at 145% of the Missouri 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 Missouri?
Compare your negotiated rates for these codes with Missouri medians for each payer.