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
What the data shows
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.
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.
Blue Cross Blue Shield's Texas rates sit 31% below its own national level, the 49th highest of its 51 states.
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%.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 124 | 1 | 81% | 824 | |
| Cigna | 108 | 2 | 11% | 822 | |
| Aetna | 95 | 3 | 5% | 764 | |
| Blue Cross Blue Shield | 88 | 4 | 4% | 1,003 |
Where Blue Cross Blue Shield pays most and least against the Texas market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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 Texas
| Licensee file set | Sampled providers |
|---|---|
| BCBS TX | 974 |
| Community Insurance Company | 85 |
| HealthKeepers, Inc. | 37 |
| Healthy Alliance Life Insurance Company | 29 |
| Anthem (Elevance) | 24 |
| BCBS NM | 22 |
| BCBS NC | 12 |
| BCBS IL | 12 |
| Matthew Thornton Health Plan, Inc. | 11 |
| Compcare Health Services Insurance Corporation | 11 |
| Blue Shield of California Life & Health Insurance Company | 10 |
| BS CA | 9 |
| BCBS OK | 8 |
| BCBS TN | 8 |
| Wellmark | 8 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 7 |
| BCBS MA | 7 |
| Carefirst BCBS | 6 |
| BCBS KS | 6 |
| HMO Colorado, Inc. | 5 |
| BCBS MI | 5 |
| BCBS MN | 5 |
| Blue Cross Blue Shield of North Dakota | 4 |
| BCBS RI | 4 |
| Regence | 4 |
| BCBS NJ (Horizon) | 2 |
| BCBS HI | 2 |
| BCBS Kansas City | 2 |
| BCBS AL | 2 |
| Horizon Healthcare of New Jersey | 2 |
| Excellus BCBS | 2 |
| HMO Missouri, Inc. | 1 |
| Capital BlueCross | 1 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| Blue Cross Blue Shield of Wyoming | 1 |
| BCBS MS | 1 |
| BCBS VT | 1 |
| BCBS MT | 1 |
| Capital BC | 1 |
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
- 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 Texas?
Compare your negotiated rates for these codes with Texas medians for each payer.