Blue Cross Blue Shield · North Carolina · commercial in-network
Blue Cross Blue Shield negotiated rates in North Carolina
How Blue Cross Blue Shield's North Carolina rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in North Carolina at a glance
Across 224 procedure codes for 8 specialties
Rate index vs state market
100
0% above the North Carolina median
Rank in state
3 of 4
UHC 111 · Cigna 103 · BCBS 100 · Aetna 64
vs own national
100
BCBS's level vs its national median
Codes where highest
22%
of 224 codes
What the data shows
Generated from North Carolina and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 3rd of 4 payers in North Carolina with a rate index of 100 (100 = the North Carolina market median), across 224 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 22% of codes in North Carolina; UnitedHealthcare leads with an index of 111 in the files analyzed.
3
Blue Cross Blue Shield's North Carolina rates sit 0% above its own national level, the 23rd highest of its 51 states.
4
Largest premium over the North Carolina market: CPT 45388 (Colonoscopy w/ablation) at 169% of market; largest discount: CPT 93458 (L hrt artery/ventricle angio) at 47%.
5
In North Carolina, BCBS rates come from 40 licensee file sets; the largest is BCBS NC (932 sampled providers).
How the four payers compare in North Carolina
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 111 | 1 | 46% | 747 | |
| Cigna | 103 | 2 | 31% | 851 | |
| Blue Cross Blue Shield | 100 | 3 | 22% | 976 | |
| Aetna | 64 | 4 | 1% | 568 |
Where Blue Cross Blue Shield pays most and least against the North Carolina market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 45388 Colonoscopy w/ablation | $1,037 | $614 | +69% | 121 |
| 67028 Injection eye drug | $274 | $176 | +56% | 113 |
| 64566 Neuroeltrd stim post tibial | $144 | $95 | +51% | 119 |
| 45378 Diagnostic colonoscopy | $708 | $513 | +38% | 122 |
| 43249 Esoph egd dilation <30 mm | $397 | $293 | +36% | 122 |
| 45385 Colonoscopy w/lesion removal | $926 | $693 | +34% | 240 |
| 43242 Egd us fine needle bx/aspir | $775 | $585 | +32% | 122 |
| 99487 Cplx chrnc care 1st 60 min | $141 | $109 | +29% | 118 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93458 L hrt artery/ventricle angio | $694 | $1,487 | -53% | 106 |
| 74183 Mri abd w/o cntr flwd cntr | $454 | $967 | -53% | 43 |
| 72197 Mri pelvis w/o & w/dye | $460 | $953 | -52% | 41 |
| 72141 Mri neck spine w/o dye | $254 | $504 | -50% | 43 |
| 71250 Ct thorax dx c- | $190 | $351 | -46% | 45 |
| 70553 Mri brain stem w/o & w/dye | $426 | $785 | -46% | 43 |
| 70551 Mri brain stem w/o dye | $283 | $520 | -46% | 42 |
| 72158 Mri lumbar spine w/o & w/dye | $431 | $774 | -44% | 43 |
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 North Carolina
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| BCBS NC | 932 |
| Community Insurance Company | 109 |
| HealthKeepers, Inc. | 53 |
| BCBS TX | 24 |
| Healthy Alliance Life Insurance Company | 21 |
| Carefirst BCBS | 20 |
| Matthew Thornton Health Plan, Inc. | 15 |
| Anthem (Elevance) | 13 |
| BCBS MI | 12 |
| BCBS IL | 10 |
| BCBS TN | 10 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 8 |
| BCBS NJ (Horizon) | 7 |
| BS CA | 7 |
| Horizon Healthcare of New Jersey | 7 |
| Blue Shield of California Life & Health Insurance Company | 7 |
| Compcare Health Services Insurance Corporation | 7 |
| BCBS MA | 6 |
| Premera | 6 |
| HMO Colorado, Inc. | 4 |
| Regence | 4 |
| BCBS KS | 3 |
| BCBS MT | 3 |
| BCBS RI | 3 |
| Capital BlueCross | 3 |
| Excellus BCBS | 3 |
| Wellmark | 3 |
| Blue Cross and Blue Shield of Nebraska | 3 |
| Capital BC | 3 |
| BCBS HI | 2 |
| BCBS Kansas City | 2 |
| BCBS VT | 2 |
| Blue Cross Blue Shield of Wyoming | 1 |
| Blue Cross Blue Shield of North Dakota | 1 |
| BCBS NM | 1 |
| HMO Missouri, Inc. | 1 |
| BCBS AL | 1 |
| Blue Cross and Blue Shield of Massachusetts, Inc. | 1 |
| BCBS OK | 1 |
| BCBS MN | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in North Carolina?
Blue Cross Blue Shield ranks 3rd of 4 in North Carolina with an index of 100. It is highest on 22% of codes.
Are Blue Cross Blue Shield's North Carolina rates above or below its national level?
About 0% above.
Which procedure does Blue Cross Blue Shield pay most above market in North Carolina?
CPT 45388 (Colonoscopy w/ablation), at 169% of the North Carolina 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 North Carolina?
Compare your negotiated rates for these codes with North Carolina medians for each payer.