Blue Cross Blue Shield negotiated rates in New York
How Blue Cross Blue Shield's New York rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in New York at a glance
What the data shows
Blue Cross Blue Shield ranks 3rd of 4 payers in New York with a rate index of 97 (100 = the New York market median), across 228 procedure codes.
Blue Cross Blue Shield has the highest median for only 8% of codes in New York; UnitedHealthcare leads with an index of 128 in the files analyzed.
Blue Cross Blue Shield's New York rates sit 16% below its own national level, the 39th highest of its 51 states.
Largest premium over the New York market: CPT 36482 (Endoven ther chem adhes 1st) at 396% of market; largest discount: CPT 51798 (Us urine capacity measure) at 56%.
In New York, BCBS rates come from 37 licensee file sets; the largest is Community Insurance Company (763 sampled providers).
How the four payers compare in New York
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 128 | 1 | 41% | 801 | |
| Cigna | 120 | 2 | 46% | 672 | |
| Blue Cross Blue Shield | 97 | 3 | 8% | 898 | |
| Aetna | 83 | 4 | 5% | 755 |
Where Blue Cross Blue Shield pays most and least against the New York market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 36482 Endoven ther chem adhes 1st | $1,125 | $284 | +296% | 40 |
| 43249 Esoph egd dilation <30 mm | $985 | $372 | +165% | 104 |
| 93298 Rem interrog dev eval scrms | $113 | $58 | +94% | 115 |
| 36465 Njx noncmpnd sclrsnt 1 vein | $270 | $190 | +42% | 39 |
| 65778 Cover eye w/membrane | $88 | $64 | +37% | 16 |
| 96413 Chemo iv infusion 1 hr | $283 | $211 | +34% | 127 |
| 93297 Rem interrog dev eval icpms | $69 | $52 | +31% | 115 |
| 11102 Tangntl bx skin single les | $119 | $92 | +30% | 92 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 51798 Us urine capacity measure | $13 | $23 | -44% | 109 |
| 64721 Carpal tunnel surgery | $458 | $682 | -33% | 103 |
| 72141 Mri neck spine w/o dye | $256 | $370 | -31% | 120 |
| 20550 Njx 1 tendon sheath/ligament | $50 | $73 | -31% | 103 |
| 43259 Egd us exam duodenum/jejunum | $214 | $307 | -30% | 122 |
| 43264 Ercp remove duct calculi | $347 | $498 | -30% | 122 |
| 70551 Mri brain stem w/o dye | $262 | $370 | -29% | 118 |
| 27487 Revise/replace knee joint | $1,890 | $2,641 | -28% | 103 |
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 York
| Licensee file set | Sampled providers |
|---|---|
| Community Insurance Company | 763 |
| Excellus BCBS | 178 |
| BCBS NJ (Horizon) | 89 |
| Horizon Healthcare of New Jersey | 89 |
| HealthKeepers, Inc. | 34 |
| Matthew Thornton Health Plan, Inc. | 31 |
| Healthy Alliance Life Insurance Company | 19 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 14 |
| BCBS TX | 12 |
| BCBS MA | 12 |
| BS CA | 7 |
| Blue Shield of California Life & Health Insurance Company | 7 |
| BCBS VT | 7 |
| Anthem (Elevance) | 7 |
| BCBS IL | 6 |
| Compcare Health Services Insurance Corporation | 6 |
| Blue Cross Blue Shield of North Dakota | 5 |
| Carefirst BCBS | 5 |
| BCBS RI | 4 |
| BCBS MN | 4 |
| Wellmark | 4 |
| BCBS NC | 4 |
| BCBS TN | 4 |
| BCBS MI | 3 |
| BCBS AZ | 2 |
| HMO Colorado, Inc. | 2 |
| Premera | 2 |
| Capital BC | 2 |
| Capital BlueCross | 2 |
| BCBS NM | 2 |
| BCBS KS | 2 |
| BCBS HI | 1 |
| Blue Cross Blue Shield of Wyoming | 1 |
| BCBS MS | 1 |
| BCBS MT | 1 |
| BCBS OK | 1 |
| BCBS AL | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in New York?
Blue Cross Blue Shield ranks 3rd of 4 in New York with an index of 97. It is highest on 8% of codes.
Are Blue Cross Blue Shield's New York rates above or below its national level?
About 16% below.
Which procedure does Blue Cross Blue Shield pay most above market in New York?
CPT 36482 (Endoven ther chem adhes 1st), at 396% of the New York 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 York?
Compare your negotiated rates for these codes with New York medians for each payer.