Blue Cross Blue Shield · Vermont · commercial in-network
Blue Cross Blue Shield negotiated rates in Vermont
How Blue Cross Blue Shield's Vermont rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Vermont at a glance
Across 224 procedure codes for 8 specialties
Rate index vs state market
89
11% below the Vermont median
Rank in state
3 of 4
UHC 142 · Cigna 109 · BCBS 89 · Aetna 74
vs own national
95
BCBS's level vs its national median
Codes where highest
4%
of 224 codes
What the data shows
Generated from Vermont and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 3rd of 4 payers in Vermont with a rate index of 89 (100 = the Vermont market median), across 224 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 4% of codes in Vermont; UnitedHealthcare leads with an index of 142 in the files analyzed.
3
Blue Cross Blue Shield's Vermont rates sit 5% below its own national level, the 28th highest of its 51 states.
4
Largest premium over the Vermont market: CPT 36465 (Njx noncmpnd sclrsnt 1 vein) at 542% of market; largest discount: CPT 93015 (Cv stress test supvj i&r) at 51%.
5
In Vermont, BCBS rates come from 29 licensee file sets; the largest is BCBS VT (257 sampled providers).
How the four payers compare in Vermont
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 142 | 1 | 79% | 279 | |
| Cigna | 109 | 2 | 18% | 302 | |
| Blue Cross Blue Shield | 89 | 3 | 4% | 312 | |
| Aetna | 74 | 4 | 0% | 279 |
Where Blue Cross Blue Shield pays most and least against the Vermont market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 36465 Njx noncmpnd sclrsnt 1 vein | $1,039 | $192 | +442% | 18 |
| 36482 Endoven ther chem adhes 1st | $1,338 | $284 | +370% | 18 |
| 33285 Insj subq car rhythm mntr | $290 | $141 | +105% | 18 |
| 52224 Cystoscopy and treatment | $624 | $488 | +28% | 23 |
| 88342 Imhchem/imcytchm 1st antb | $139 | $109 | +28% | 19 |
| 43235 Egd diagnostic brush wash | $503 | $400 | +26% | 21 |
| 64721 Carpal tunnel surgery | $885 | $748 | +18% | 33 |
| 45378 Diagnostic colonoscopy | $643 | $550 | +17% | 21 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93015 Cv stress test supvj i&r | $77 | $149 | -49% | 23 |
| 93925 Lower extremity study | $212 | $401 | -47% | 18 |
| 93000 Electrocardiogram complete | $18 | $30 | -41% | 258 |
| 99454 Rem mntr physiol param 16-30 | $55 | $88 | -38% | 108 |
| 99497 Advncd care plan 30 min | $75 | $120 | -37% | 69 |
| 22551 Arthrd ant ntrbdy cervical | $1,805 | $2,878 | -37% | 33 |
| 93294 Rem interrog evl pm/ldls pm | $33 | $52 | -37% | 24 |
| 55866 Laps surg prst8ect rpbic rad | $1,546 | $2,387 | -35% | 28 |
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 Vermont
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| BCBS VT | 257 |
| Excellus BCBS | 154 |
| Community Insurance Company | 71 |
| Compcare Health Services Insurance Corporation | 57 |
| Anthem (Elevance) | 26 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 24 |
| BCBS MA | 23 |
| Healthy Alliance Life Insurance Company | 11 |
| Matthew Thornton Health Plan, Inc. | 6 |
| BCBS IL | 5 |
| BCBS MN | 3 |
| Blue Cross Blue Shield of North Dakota | 3 |
| HealthKeepers, Inc. | 3 |
| BCBS MI | 3 |
| BCBS TX | 3 |
| BS CA | 2 |
| Capital BlueCross | 2 |
| Blue Shield of California Life & Health Insurance Company | 2 |
| Capital BC | 2 |
| Premera | 2 |
| Regence | 2 |
| BCBS MS | 1 |
| Blue Cross and Blue Shield of Massachusetts, Inc. | 1 |
| Blue Cross Blue Shield of Wyoming | 1 |
| BCBS NC | 1 |
| BCBS RI | 1 |
| HMO Colorado, Inc. | 1 |
| BCBS TN | 1 |
| Wellmark | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Vermont?
Blue Cross Blue Shield ranks 3rd of 4 in Vermont with an index of 89. It is highest on 4% of codes.
Are Blue Cross Blue Shield's Vermont rates above or below its national level?
About 5% below.
Which procedure does Blue Cross Blue Shield pay most above market in Vermont?
CPT 36465 (Njx noncmpnd sclrsnt 1 vein), at 542% of the Vermont 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 Vermont?
Compare your negotiated rates for these codes with Vermont medians for each payer.