Blue Cross Blue Shield negotiated rates in Pennsylvania
How Blue Cross Blue Shield's Pennsylvania rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Pennsylvania at a glance
What the data shows
Blue Cross Blue Shield ranks 2nd of 4 payers in Pennsylvania with a rate index of 101 (100 = the Pennsylvania market median), across 228 procedure codes.
Blue Cross Blue Shield has the highest median for only 18% of codes in Pennsylvania; UnitedHealthcare leads with an index of 115 in the files analyzed.
Blue Cross Blue Shield's Pennsylvania rates sit 3% below its own national level, the 25th highest of its 51 states.
Largest premium over the Pennsylvania market: CPT 93298 (Rem interrog dev eval scrms) at 194% of market; largest discount: CPT 45390 (Colonoscopy w/resection) at 72%.
In Pennsylvania, BCBS rates come from 30 licensee file sets; the largest is Capital BlueCross (290 sampled providers).
How the four payers compare in Pennsylvania
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 115 | 1 | 75% | 751 | |
| Blue Cross Blue Shield | 101 | 2 | 18% | 564 | |
| Cigna | 94 | 3 | 2% | 788 | |
| Aetna | 82 | 4 | 5% | 679 |
Where Blue Cross Blue Shield pays most and least against the Pennsylvania market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $97 | $50 | +94% | 55 |
| 45388 Colonoscopy w/ablation | $796 | $473 | +68% | 83 |
| 12032 Intmd rpr s/a/t/ext 2.6-7.5 | $422 | $277 | +52% | 44 |
| 17262 Dstrj mal les t/a/l 1.1-2.0 | $243 | $161 | +51% | 39 |
| 12042 Intmd rpr n-hf/genit2.6-7.5 | $398 | $275 | +45% | 37 |
| 13152 Cmplx rpr e/n/e/l 2.6-7.5 cm | $675 | $470 | +44% | 40 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $270 | $189 | +43% | 36 |
| 64566 Neuroeltrd stim post tibial | $109 | $77 | +41% | 55 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 45390 Colonoscopy w/resection | $339 | $472 | -28% | 87 |
| 43246 Egd place gastrostomy tube | $231 | $303 | -24% | 79 |
| 43238 Egd us fine needle bx/aspir | $263 | $343 | -23% | 87 |
| 92004 Compre oph exam new pt 1/> | $80 | $103 | -22% | 67 |
| 33285 Insj subq car rhythm mntr | $98 | $125 | -21% | 26 |
| 43259 Egd us exam duodenum/jejunum | $274 | $341 | -20% | 79 |
| 43276 Ercp stent exchange w/dilate | $578 | $712 | -19% | 87 |
| 43274 Ercp duct stent placement | $556 | $683 | -19% | 87 |
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 Pennsylvania
| Licensee file set | Sampled providers |
|---|---|
| Capital BlueCross | 290 |
| Capital BC | 286 |
| Horizon Healthcare of New Jersey | 200 |
| BCBS NJ (Horizon) | 196 |
| Community Insurance Company | 108 |
| HealthKeepers, Inc. | 51 |
| Excellus BCBS | 29 |
| Healthy Alliance Life Insurance Company | 27 |
| Carefirst BCBS | 21 |
| BCBS TX | 16 |
| BCBS NC | 11 |
| BS CA | 11 |
| Blue Shield of California Life & Health Insurance Company | 11 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 10 |
| Anthem (Elevance) | 10 |
| BCBS MA | 9 |
| Matthew Thornton Health Plan, Inc. | 9 |
| BCBS IL | 8 |
| Compcare Health Services Insurance Corporation | 5 |
| BCBS MI | 5 |
| BCBS RI | 5 |
| Wellmark | 4 |
| BCBS MN | 4 |
| HMO Colorado, Inc. | 3 |
| BCBS TN | 2 |
| BCBS KS | 1 |
| BCBS OK | 1 |
| Regence | 1 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| Premera | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Pennsylvania?
Blue Cross Blue Shield ranks 2nd of 4 in Pennsylvania with an index of 101. It is highest on 18% of codes.
Are Blue Cross Blue Shield's Pennsylvania rates above or below its national level?
About 3% below.
Which procedure does Blue Cross Blue Shield pay most above market in Pennsylvania?
CPT 93298 (Rem interrog dev eval scrms), at 194% of the Pennsylvania 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 Pennsylvania?
Compare your negotiated rates for these codes with Pennsylvania medians for each payer.