Blue Cross Blue Shield negotiated rates in West Virginia
How Blue Cross Blue Shield's West Virginia rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in West Virginia at a glance
What the data shows
Blue Cross Blue Shield ranks 3rd of 4 payers in West Virginia with a rate index of 78 (100 = the West Virginia market median), across 194 procedure codes.
Blue Cross Blue Shield has the highest median for only 1% of codes in West Virginia; UnitedHealthcare leads with an index of 130 in the files analyzed.
Blue Cross Blue Shield's West Virginia rates sit 26% below its own national level, the 46th highest of its 51 states.
Largest premium over the West Virginia market: CPT 88305 (Tissue exam by pathologist) at 126% of market; largest discount: CPT 64566 (Neuroeltrd stim post tibial) at 41%.
In West Virginia, BCBS rates come from 30 licensee file sets; the largest is Community Insurance Company (196 sampled providers).
How the four payers compare in West Virginia
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 130 | 1 | 70% | 512 | |
| Cigna | 110 | 2 | 30% | 518 | |
| Blue Cross Blue Shield | 78 | 3 | 1% | 292 | |
| Aetna | 76 | 4 | 0% | 329 |
Where Blue Cross Blue Shield pays most and least against the West Virginia market
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 88305 Tissue exam by pathologist | $93 | $74 | +26% | 32 |
| 96413 Chemo iv infusion 1 hr | $219 | $189 | +16% | 23 |
| 93296 Rem interrog evl pm/ids | $39 | $35 | +9% | 38 |
| 92083 Extended visual field xm | $69 | $64 | +9% | 31 |
| 92136 Ophthalmic biometry | $63 | $59 | +8% | 31 |
| 92025 Cptrized corneal topography | $36 | $34 | +6% | 31 |
| 92134 Cptrz oph dx img pst sgm rta | $43 | $40 | +6% | 31 |
| 92133 Cptrzd oph dx img pst sgm on | $41 | $38 | +6% | 31 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 64566 Neuroeltrd stim post tibial | $34 | $82 | -59% | 26 |
| 88312 Special stains group 1 | $40 | $83 | -52% | 32 |
| 43239 Egd biopsy single/multiple | $162 | $303 | -47% | 23 |
| 43235 Egd diagnostic brush wash | $137 | $251 | -46% | 23 |
| 46221 Ligation of hemorrhoid(s) | $162 | $283 | -43% | 23 |
| 51702 Insert temp bladder cath | $38 | $65 | -42% | 26 |
| 45384 Colonoscopy w/lesion removal | $259 | $441 | -41% | 23 |
| 45390 Colonoscopy w/resection | $292 | $496 | -41% | 23 |
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 West Virginia
| Licensee file set | Sampled providers |
|---|---|
| Community Insurance Company | 196 |
| Healthy Alliance Life Insurance Company | 106 |
| Anthem (Elevance) | 71 |
| Carefirst BCBS | 22 |
| BCBS TX | 21 |
| HealthKeepers, Inc. | 21 |
| BCBS NC | 20 |
| BCBS IL | 11 |
| BCBS TN | 9 |
| Matthew Thornton Health Plan, Inc. | 8 |
| BCBS MI | 5 |
| BCBS MN | 5 |
| Regence | 5 |
| Premera | 4 |
| Wellmark | 4 |
| Blue Cross and Blue Shield of Nebraska | 4 |
| BCBS NJ (Horizon) | 3 |
| Horizon Healthcare of New Jersey | 3 |
| Compcare Health Services Insurance Corporation | 2 |
| BCBS KS | 2 |
| Capital BC | 2 |
| BCBS MA | 2 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 2 |
| Capital BlueCross | 2 |
| Blue Cross Blue Shield of North Dakota | 2 |
| BCBS Kansas City | 2 |
| Excellus BCBS | 1 |
| BCBS OK | 1 |
| BCBS NM | 1 |
| BCBS AL | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in West Virginia?
Blue Cross Blue Shield ranks 3rd of 4 in West Virginia with an index of 78. It is highest on 1% of codes.
Are Blue Cross Blue Shield's West Virginia rates above or below its national level?
About 26% below.
Which procedure does Blue Cross Blue Shield pay most above market in West Virginia?
CPT 88305 (Tissue exam by pathologist), at 126% of the West 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 West Virginia?
Compare your negotiated rates for these codes with West Virginia medians for each payer.