Blue Cross Blue Shield · Texas · commercial in-network

Blue Cross Blue Shield negotiated rates in Texas

How Blue Cross Blue Shield's Texas rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.

Blue Cross Blue Shield in Texas at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
88
12% below the Texas median
Rank in state
4 of 4
UHC 124 · Cigna 108 · Aetna 95 · BCBS 88
vs own national
69
BCBS's level vs its national median
Codes where highest
4%
of 228 codes
1,003 sampled providers895 TINs228 codesMedian 91% of Medicare · method

What the data shows

Generated from Texas and Blue Cross Blue Shield data only
1

Blue Cross Blue Shield ranks 4th of 4 payers in Texas with a rate index of 88 (100 = the Texas market median), across 228 procedure codes.

2

Blue Cross Blue Shield has the highest median for only 4% of codes in Texas; UnitedHealthcare leads with an index of 124 in the files analyzed.

3

Blue Cross Blue Shield's Texas rates sit 31% below its own national level, the 49th highest of its 51 states.

4

Largest premium over the Texas market: CPT 93298 (Rem interrog dev eval scrms) at 195% of market; largest discount: CPT 88313 (Special stains group 2) at 14%.

5

In Texas, BCBS rates come from 39 licensee file sets; the largest is BCBS TX (974 sampled providers).

How the four payers compare in Texas

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1241
124
81%824
Cigna1082
108
11%822
Aetna953
95
5%764
Blue Cross Blue Shield884
88
4%1,003

Where Blue Cross Blue Shield pays most and least against the Texas market

Codes with the largest gap to the state median

Highest above market

CodeBCBSMarketGapProv.
93298
Rem interrog dev eval scrms
$100$51+95%130
93297
Rem interrog dev eval icpms
$60$52+16%130
92012
Intrm oph exam est patient
$77$68+14%122
96910
Photchmtx tar&uvb/ptrltm&uvb
$137$125+9%131
92273
Full field erg w/i&r
$144$133+9%120
17313
Mohs 1 stage t/a/l
$483$446+8%130
17311
Mohs 1 stage h/n/hf/g
$538$497+8%131
11104
Punch bx skin single lesion
$71$66+8%131

Furthest below market

CodeBCBSMarketGapProv.
88313
Special stains group 2
$6$45-86%129
77280
Ther rad simulaj field smpl
$35$230-85%131
78452
Ht muscle image spect mult
$73$428-83%236
91110
Gi trc img intral esoph-ile
$152$879-83%130
76872
Us transrectal
$32$149-79%115
93925
Lower extremity study
$59$260-77%130
88312
Special stains group 1
$14$61-77%260
73562
X-ray exam of knee 3
$8$34-76%120

Where Blue Cross Blue Shield pays above and below its national level

Index vs the payer's own national median (100 = national)

Highest states

StateIndexProv.
Alaska243
290
Wisconsin192
733
Minnesota171
671
North Dakota148
329
Wyoming145
256

Lowest states

StateIndexProv.
Maryland63
758
Arizona66
479
Texas69
1,003
District of Columbia69
484
New Mexico74
562

Blue Cross Blue Shield licensees in Texas

File sets contributing rates; licensees are different companies
Licensee file setSampled providers
BCBS TX974
Community Insurance Company85
HealthKeepers, Inc.37
Healthy Alliance Life Insurance Company29
Anthem (Elevance)24
BCBS NM22
BCBS NC12
BCBS IL12
Matthew Thornton Health Plan, Inc.11
Compcare Health Services Insurance Corporation11
Blue Shield of California Life & Health Insurance Company10
BS CA9
BCBS OK8
BCBS TN8
Wellmark8
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.7
BCBS MA7
Carefirst BCBS6
BCBS KS6
HMO Colorado, Inc.5
BCBS MI5
BCBS MN5
Blue Cross Blue Shield of North Dakota4
BCBS RI4
Regence4
BCBS NJ (Horizon)2
BCBS HI2
BCBS Kansas City2
BCBS AL2
Horizon Healthcare of New Jersey2
Excellus BCBS2
HMO Missouri, Inc.1
Capital BlueCross1
Blue Cross and Blue Shield of Nebraska1
Blue Cross Blue Shield of Wyoming1
BCBS MS1
BCBS VT1
BCBS MT1
Capital BC1

Frequently asked questions

Does Blue Cross Blue Shield pay more or less than the other payers in Texas?

Blue Cross Blue Shield ranks 4th of 4 in Texas with an index of 88. It is highest on 4% of codes.

Are Blue Cross Blue Shield's Texas rates above or below its national level?

About 31% below.

Which procedure does Blue Cross Blue Shield pay most above market in Texas?

CPT 93298 (Rem interrog dev eval scrms), at 195% of the Texas 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.

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