Blue Cross Blue Shield · Ohio · commercial in-network
Blue Cross Blue Shield negotiated rates in Ohio
How Blue Cross Blue Shield's Ohio rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Ohio at a glance
Across 228 procedure codes for 8 specialties
Rate index vs state market
95
5% below the Ohio median
Rank in state
2 of 4
UHC 115 · BCBS 95 · Cigna 95 · Aetna 88
vs own national
94
BCBS's level vs its national median
Codes where highest
13%
of 228 codes
What the data shows
Generated from Ohio and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 2nd of 4 payers in Ohio with a rate index of 95 (100 = the Ohio market median), across 228 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 13% of codes in Ohio; UnitedHealthcare leads with an index of 115 in the files analyzed.
3
Blue Cross Blue Shield's Ohio rates sit 6% below its own national level, the 29th highest of its 51 states.
4
Largest premium over the Ohio market: CPT 51798 (Us urine capacity measure) at 147% of market; largest discount: CPT 93229 (Remote 30 day ecg tech supp) at 30%.
5
In Ohio, BCBS rates come from 38 licensee file sets; the largest is Community Insurance Company (861 sampled providers).
How the four payers compare in Ohio
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 115 | 1 | 76% | 802 | |
| Blue Cross Blue Shield | 95 | 2 | 13% | 893 | |
| Cigna | 95 | 3 | 5% | 806 | |
| Aetna | 88 | 4 | 6% | 711 |
Where Blue Cross Blue Shield pays most and least against the Ohio market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 51798 Us urine capacity measure | $33 | $23 | +47% | 106 |
| 88305 Tissue exam by pathologist | $106 | $78 | +36% | 225 |
| 92250 Fundus photography w/i&r | $73 | $54 | +36% | 99 |
| 77080 Dxa bone density axial | $100 | $76 | +32% | 115 |
| 76512 Oph us dx b-scan | $94 | $73 | +29% | 100 |
| 72148 Mri lumbar spine w/o dye | $468 | $380 | +23% | 219 |
| 96413 Chemo iv infusion 1 hr | $267 | $219 | +22% | 115 |
| 88313 Special stains group 2 | $86 | $71 | +22% | 97 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93229 Remote 30 day ecg tech supp | $296 | $993 | -70% | 111 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $62 | $108 | -43% | 111 |
| 88312 Special stains group 1 | $52 | $83 | -38% | 224 |
| 88342 Imhchem/imcytchm 1st antb | $52 | $79 | -34% | 109 |
| 77280 Ther rad simulaj field smpl | $186 | $283 | -34% | 111 |
| 46221 Ligation of hemorrhoid(s) | $223 | $317 | -30% | 114 |
| 45384 Colonoscopy w/lesion removal | $340 | $482 | -30% | 114 |
| 64566 Neuroeltrd stim post tibial | $54 | $76 | -29% | 106 |
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 Ohio
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| Community Insurance Company | 861 |
| Healthy Alliance Life Insurance Company | 851 |
| HealthKeepers, Inc. | 61 |
| BCBS MI | 41 |
| Anthem (Elevance) | 28 |
| BCBS IL | 14 |
| BCBS TX | 13 |
| BCBS MN | 10 |
| Matthew Thornton Health Plan, Inc. | 10 |
| Wellmark | 9 |
| Carefirst BCBS | 8 |
| Compcare Health Services Insurance Corporation | 8 |
| BS CA | 7 |
| BCBS TN | 7 |
| Blue Shield of California Life & Health Insurance Company | 7 |
| Horizon Healthcare of New Jersey | 6 |
| BCBS NC | 6 |
| BCBS NJ (Horizon) | 6 |
| HMO Colorado, Inc. | 5 |
| Regence | 5 |
| Premera | 4 |
| BCBS KS | 4 |
| Blue Cross Blue Shield of Wyoming | 4 |
| BCBS OK | 3 |
| Blue Cross Blue Shield of North Dakota | 3 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 2 |
| BCBS HI | 2 |
| Capital BC | 2 |
| BCBS VT | 2 |
| BCBS MA | 2 |
| Capital BlueCross | 2 |
| BCBS MS | 1 |
| BCBS AZ | 1 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| HMO Missouri, Inc. | 1 |
| Excellus BCBS | 1 |
| BCBS RI | 1 |
| BCBS NM | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Ohio?
Blue Cross Blue Shield ranks 2nd of 4 in Ohio with an index of 95. It is highest on 13% of codes.
Are Blue Cross Blue Shield's Ohio rates above or below its national level?
About 6% below.
Which procedure does Blue Cross Blue Shield pay most above market in Ohio?
CPT 51798 (Us urine capacity measure), at 147% of the Ohio 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 Ohio?
Compare your negotiated rates for these codes with Ohio medians for each payer.