Blue Cross Blue Shield negotiated rates in Virginia
How Blue Cross Blue Shield's Virginia rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Virginia at a glance
What the data shows
Blue Cross Blue Shield ranks 4th of 4 payers in Virginia with a rate index of 87 (100 = the Virginia market median), across 228 procedure codes.
Blue Cross Blue Shield has the highest median for only 4% of codes in Virginia; UnitedHealthcare leads with an index of 116 in the files analyzed.
Blue Cross Blue Shield's Virginia rates sit 22% below its own national level, the 44th highest of its 51 states.
Largest premium over the Virginia market: CPT 93298 (Rem interrog dev eval scrms) at 239% of market; largest discount: CPT 88313 (Special stains group 2) at 50%.
In Virginia, BCBS rates come from 37 licensee file sets; the largest is Community Insurance Company (761 sampled providers).
How the four payers compare in Virginia
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 116 | 1 | 64% | 733 | |
| Cigna | 102 | 2 | 20% | 787 | |
| Aetna | 93 | 3 | 12% | 752 | |
| Blue Cross Blue Shield | 87 | 4 | 4% | 813 |
Where Blue Cross Blue Shield pays most and least against the Virginia market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $108 | $45 | +139% | 120 |
| 93297 Rem interrog dev eval icpms | $68 | $46 | +47% | 120 |
| 92235 Fluorescein angrph mltiframe | $172 | $145 | +19% | 92 |
| 73560 X-ray exam of knee 1 or 2 | $49 | $42 | +17% | 84 |
| 76872 Us transrectal | $226 | $193 | +17% | 86 |
| 77280 Ther rad simulaj field smpl | $286 | $259 | +10% | 109 |
| 99490 Chrnc care mgmt staff 1st 20 | $65 | $60 | +8% | 406 |
| 73030 X-ray exam of shoulder | $44 | $41 | +8% | 86 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 88313 Special stains group 2 | $29 | $57 | -50% | 111 |
| 45384 Colonoscopy w/lesion removal | $258 | $483 | -47% | 111 |
| 43235 Egd diagnostic brush wash | $161 | $298 | -46% | 111 |
| 45380 Colonoscopy and biopsy | $240 | $434 | -45% | 111 |
| 64566 Neuroeltrd stim post tibial | $35 | $63 | -44% | 89 |
| 45378 Diagnostic colonoscopy | $203 | $362 | -44% | 111 |
| 88312 Special stains group 1 | $40 | $67 | -41% | 220 |
| 72148 Mri lumbar spine w/o dye | $239 | $405 | -41% | 193 |
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 Virginia
| Licensee file set | Sampled providers |
|---|---|
| Community Insurance Company | 761 |
| Carefirst BCBS | 246 |
| BCBS NC | 50 |
| HealthKeepers, Inc. | 46 |
| Healthy Alliance Life Insurance Company | 24 |
| BCBS TX | 21 |
| Anthem (Elevance) | 16 |
| Matthew Thornton Health Plan, Inc. | 15 |
| BS CA | 11 |
| BCBS IL | 10 |
| Blue Shield of California Life & Health Insurance Company | 10 |
| BCBS MI | 9 |
| Regence | 7 |
| Compcare Health Services Insurance Corporation | 7 |
| Capital BC | 6 |
| Capital BlueCross | 6 |
| Excellus BCBS | 6 |
| Horizon Healthcare of New Jersey | 5 |
| BCBS NJ (Horizon) | 5 |
| BCBS MA | 3 |
| Wellmark | 3 |
| BCBS OK | 3 |
| Premera | 3 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 3 |
| BCBS MT | 2 |
| BCBS NM | 2 |
| BCBS RI | 2 |
| BCBS MN | 2 |
| HMO Colorado, Inc. | 2 |
| BCBS TN | 2 |
| BCBS AZ | 1 |
| BCBS HI | 1 |
| Blue Cross and Blue Shield of Nebraska | 1 |
| HMO Missouri, Inc. | 1 |
| Blue Cross Blue Shield of North Dakota | 1 |
| BCBS AL | 1 |
| BCBS KS | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Virginia?
Blue Cross Blue Shield ranks 4th of 4 in Virginia with an index of 87. It is highest on 4% of codes.
Are Blue Cross Blue Shield's Virginia rates above or below its national level?
About 22% below.
Which procedure does Blue Cross Blue Shield pay most above market in Virginia?
CPT 93298 (Rem interrog dev eval scrms), at 239% of the Virginia 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 Virginia?
Compare your negotiated rates for these codes with Virginia medians for each payer.