Blue Cross Blue Shield · Wisconsin · commercial in-network
Blue Cross Blue Shield negotiated rates in Wisconsin
How Blue Cross Blue Shield's Wisconsin rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Wisconsin at a glance
Across 228 procedure codes for 8 specialties
Rate index vs state market
114
14% above the Wisconsin median
Rank in state
2 of 4
UHC 125 · BCBS 114 · Cigna 67 · Aetna 51
vs own national
192
BCBS's level vs its national median
Codes where highest
42%
of 228 codes
What the data shows
Generated from Wisconsin and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 2nd of 4 payers in Wisconsin with a rate index of 114 (100 = the Wisconsin market median), across 228 procedure codes.
2
Blue Cross Blue Shield has the highest median for only 42% of codes in Wisconsin; UnitedHealthcare leads with an index of 125 in the files analyzed.
3
Blue Cross Blue Shield's Wisconsin rates sit 92% above its own national level, the 2nd highest of its 51 states.
4
Largest premium over the Wisconsin market: CPT 76512 (Oph us dx b-scan) at 262% of market; largest discount: CPT 93656 (Compre ep eval abltj atr fib) at 82%.
5
In Wisconsin, BCBS rates come from 38 licensee file sets; the largest is Healthy Alliance Life Insurance Company (763 sampled providers).
How the four payers compare in Wisconsin
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 125 | 1 | 57% | 610 | |
| Blue Cross Blue Shield | 114 | 2 | 42% | 733 | |
| Cigna | 67 | 3 | 1% | 296 | |
| Aetna | 51 | 4 | 0% | 291 |
Where Blue Cross Blue Shield pays most and least against the Wisconsin market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 76512 Oph us dx b-scan | $256 | $98 | +162% | 84 |
| 67210 Treatment of retinal lesion | $2,320 | $1,076 | +116% | 93 |
| 66821 After cataract laser surgery | $1,422 | $672 | +112% | 93 |
| 67904 Repair eyelid defect | $2,864 | $1,448 | +98% | 98 |
| 96574 Dbrdmt prmlg les w/pdt | $875 | $446 | +96% | 76 |
| 68761 Close tear duct opening | $551 | $282 | +96% | 98 |
| 97110 Therapeutic exercises | $72 | $37 | +95% | 88 |
| 67028 Injection eye drug | $427 | $220 | +94% | 94 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 93656 Compre ep eval abltj atr fib | $1,745 | $2,134 | -18% | 77 |
| 92928 Prq tcat plmt ntrac st 1 les | $1,091 | $1,192 | -8% | 78 |
| 17311 Mohs 1 stage h/n/hf/g | $1,169 | $1,243 | -6% | 87 |
| 93015 Cv stress test supvj i&r | $156 | $162 | -4% | 78 |
| 99457 Rpm tx mgmt 1st 20 min | $80 | $83 | -3% | 171 |
| 45378 Diagnostic colonoscopy | $757 | $777 | -3% | 89 |
| 45384 Colonoscopy w/lesion removal | $944 | $965 | -2% | 89 |
| 99487 Cplx chrnc care 1st 60 min | $177 | $181 | -2% | 85 |
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 Wisconsin
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| Healthy Alliance Life Insurance Company | 763 |
| Community Insurance Company | 82 |
| BCBS IL | 59 |
| BCBS MN | 50 |
| HealthKeepers, Inc. | 40 |
| Wellmark | 22 |
| BCBS MI | 18 |
| BCBS TX | 14 |
| Anthem (Elevance) | 14 |
| Matthew Thornton Health Plan, Inc. | 14 |
| Blue Shield of California Life & Health Insurance Company | 9 |
| BS CA | 9 |
| BCBS NC | 7 |
| Regence | 6 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 4 |
| Compcare Health Services Insurance Corporation | 4 |
| Premera | 3 |
| BCBS MA | 3 |
| Carefirst BCBS | 3 |
| Excellus BCBS | 3 |
| Horizon Healthcare of New Jersey | 3 |
| HMO Colorado, Inc. | 3 |
| BCBS NJ (Horizon) | 3 |
| Blue Cross Blue Shield of North Dakota | 3 |
| BCBS TN | 3 |
| Blue Cross and Blue Shield of Nebraska | 2 |
| BCBS AZ | 2 |
| BCBS KS | 2 |
| Capital BC | 1 |
| BCBS MS | 1 |
| Capital BlueCross | 1 |
| BCBS Kansas City | 1 |
| BCBS RI | 1 |
| BCBS NM | 1 |
| BCBS MT | 1 |
| BCBS AL | 1 |
| BCBS HI | 1 |
| Blue Cross Blue Shield of Wyoming | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Wisconsin?
Blue Cross Blue Shield ranks 2nd of 4 in Wisconsin with an index of 114. It is highest on 42% of codes.
Are Blue Cross Blue Shield's Wisconsin rates above or below its national level?
About 92% above.
Which procedure does Blue Cross Blue Shield pay most above market in Wisconsin?
CPT 76512 (Oph us dx b-scan), at 262% of the Wisconsin 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 Wisconsin?
Compare your negotiated rates for these codes with Wisconsin medians for each payer.