Blue Cross Blue Shield negotiated rates in New Jersey
How Blue Cross Blue Shield's New Jersey rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in New Jersey at a glance
What the data shows
Blue Cross Blue Shield ranks 3rd of 4 payers in New Jersey with a rate index of 101 (100 = the New Jersey market median), across 228 procedure codes.
Blue Cross Blue Shield has the highest median for only 27% of codes in New Jersey; UnitedHealthcare leads with an index of 109 in the files analyzed.
Blue Cross Blue Shield's New Jersey rates sit 0% above its own national level, the 24th highest of its 51 states.
Largest premium over the New Jersey market: CPT 93298 (Rem interrog dev eval scrms) at 276% of market; largest discount: CPT 72141 (Mri neck spine w/o dye) at 73%.
In New Jersey, BCBS rates come from 34 licensee file sets; the largest is BCBS NJ (Horizon) (726 sampled providers).
How the four payers compare in New Jersey
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 109 | 1 | 43% | 724 | |
| Cigna | 104 | 2 | 24% | 795 | |
| Blue Cross Blue Shield | 101 | 3 | 27% | 787 | |
| Aetna | 82 | 4 | 7% | 807 |
Where Blue Cross Blue Shield pays most and least against the New Jersey market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $149 | $54 | +176% | 102 |
| 93297 Rem interrog dev eval icpms | $87 | $49 | +79% | 102 |
| 88305 Tissue exam by pathologist | $108 | $68 | +58% | 198 |
| 88313 Special stains group 2 | $134 | $90 | +48% | 112 |
| 88312 Special stains group 1 | $146 | $101 | +44% | 198 |
| 55866 Laps surg prst8ect rpbic rad | $3,632 | $2,639 | +38% | 90 |
| 99202 Office o/p new sf 15 min | $86 | $63 | +37% | 86 |
| 14301 Tis trnfr any 30.1-60 sq cm | $1,241 | $930 | +33% | 86 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 72141 Mri neck spine w/o dye | $292 | $402 | -27% | 104 |
| 70496 Ct angiography head | $362 | $491 | -26% | 104 |
| 70498 Ct angiography neck | $368 | $491 | -25% | 104 |
| 70551 Mri brain stem w/o dye | $303 | $404 | -25% | 104 |
| 72158 Mri lumbar spine w/o & w/dye | $482 | $638 | -24% | 104 |
| 74183 Mri abd w/o cntr flwd cntr | $518 | $683 | -24% | 104 |
| 70553 Mri brain stem w/o & w/dye | $483 | $636 | -24% | 104 |
| 77080 Dxa bone density axial | $58 | $75 | -23% | 102 |
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 New Jersey
| Licensee file set | Sampled providers |
|---|---|
| BCBS NJ (Horizon) | 726 |
| Horizon Healthcare of New Jersey | 726 |
| Community Insurance Company | 136 |
| HealthKeepers, Inc. | 44 |
| Capital BC | 25 |
| Capital BlueCross | 25 |
| Healthy Alliance Life Insurance Company | 17 |
| Matthew Thornton Health Plan, Inc. | 15 |
| Compcare Health Services Insurance Corporation | 12 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 11 |
| BCBS TX | 8 |
| BCBS MA | 7 |
| Wellmark | 6 |
| Anthem (Elevance) | 6 |
| Excellus BCBS | 6 |
| Carefirst BCBS | 6 |
| BCBS IL | 6 |
| BS CA | 5 |
| Blue Shield of California Life & Health Insurance Company | 5 |
| BCBS MI | 4 |
| HMO Colorado, Inc. | 4 |
| BCBS TN | 3 |
| Blue Cross and Blue Shield of Massachusetts, Inc. | 3 |
| Blue Cross Blue Shield of North Dakota | 3 |
| BCBS MN | 2 |
| Regence | 2 |
| BCBS NC | 2 |
| BCBS NM | 2 |
| BCBS MT | 2 |
| BCBS KS | 2 |
| BCBS RI | 1 |
| BCBS MS | 1 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| BCBS OK | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in New Jersey?
Blue Cross Blue Shield ranks 3rd of 4 in New Jersey with an index of 101. It is highest on 27% of codes.
Are Blue Cross Blue Shield's New Jersey rates above or below its national level?
About 0% above.
Which procedure does Blue Cross Blue Shield pay most above market in New Jersey?
CPT 93298 (Rem interrog dev eval scrms), at 276% of the New Jersey 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 New Jersey?
Compare your negotiated rates for these codes with New Jersey medians for each payer.