# Blue Cross Blue Shield Fee Schedule: Why There Isn’t One, and How to Find Yours

> Why there is no single Blue Cross Blue Shield fee schedule: the Blue plans are independent companies with separate contracts, BlueCard prices out-of-area claims at the local plan’s rate, and each plan publishes its own negotiated rates.

- Published: 2026-09-23
- Author: RateBench
- Human page: https://ratebench.health/blog/blue-cross-blue-shield-fee-schedule
- This document: https://ratebench.health/blog/blue-cross-blue-shield-fee-schedule.md
- Product (sign up / app): https://app.ratebench.health

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Search "Blue Cross Blue Shield fee schedule" and you are asking for something
that does not exist. Not because the rates are secret — they are published —
but because "Blue Cross Blue Shield" is not a single company. It is a brand.

Getting this right is not trivia. A practice that thinks of "BCBS" as one payer
will compare the wrong numbers, appeal to the wrong plan, and negotiate without
knowing which contract actually pays most of its Blue claims.

## The short answer

- **Blue Cross Blue Shield is more than 30 independent companies.** Each licenses the brand from the Blue Cross Blue Shield Association, contracts with providers on its own, and sets its own rates.
- **Your local Blue plan prices nearly all of your Blue claims** — including patients whose card was issued by a Blue plan in another state, through the BlueCard program.
- **Each Blue plan publishes its own negotiated rates** in machine-readable files required by the federal Transparency in Coverage rules, by network and by provider.
- **So the fee schedule you want is your local plan’s, for the network your patients are in** — and in some states there is more than one local plan.

## “Blue Cross Blue Shield” is more than 30 companies

The Blue Cross Blue Shield Association describes itself as an association of
independent, locally operated Blue Cross and Blue Shield companies. Becker's
counts 33 of them in the U.S. Mergers and affiliations move that number, which
is why you will see 33, 34 and 36 quoted — but the point stands at any count:
they are separate companies with separate contracts.

Some share a parent. That is where most of the confusion starts:

| Parent | Operates the Blue plan in |
|---|---|
| Elevance Health (Anthem) | California (Blue Cross only), Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (except 30 counties in the Kansas City area), Nevada, New Hampshire, New York (New York City metro and upstate), Ohio, Virginia (except the Northern Virginia suburbs of Washington, D.C.) and Wisconsin — 14 states |
| Health Care Service Corporation | Illinois, Montana, New Mexico, Oklahoma and Texas |
| Highmark | Pennsylvania, Delaware, West Virginia, and western and northeastern New York |
| Regence | Oregon, Utah, Idaho and Washington |

A shared parent does not mean a shared fee schedule. Elevance's Anthem plans are
contracted state by state, and the published rates show it.

## Different Blue plans, different rates

A shared brand — or a shared parent — does not mean a shared rate. Here is
what the files show. For the Blue plans whose files we pre-read every month,
this is the typical published in-network rate for **99213**, an
established-patient office visit, in their September 2026 files: the middle
rate across every provider group with one rate for the code, and the middle
half of those rates.

| Blue plan | Typical 99213 | Middle half | Provider groups |
|---|---|---|---|
| [BCBS Texas](/payers/bcbstx) | $61.95 | $44.25 – $69.03 | 307,595 |
| [Florida Blue](/payers/floridablue) | $68.78 | $66.19 – $78.60 | 36,458 |
| [Horizon BCBS New Jersey](/payers/horizon) | $73.17 | $73.17 – $83.93 | 82,149 |
| [BCBS Mississippi](/payers/bcbsms) | $92.08 | $81.00 – $92.08 | 4,164 |

For comparison, the national carriers' typical 99213 in the same month:
[Aetna](/payers/aetna) $76.71, [UnitedHealthcare](/payers/uhc) $78.43,
[Cigna](/payers/cigna) $91.00.

Two things stand out. The typical rate for the same visit is half again higher
in one Blue plan than in another — $61.95 in Texas, $92.08 in Mississippi. And
the spread inside a single plan is wide: in Texas, a quarter of provider groups
sit at or below $44.25 and a quarter at or above $69.03.

The same holds inside one parent company. Anthem's 14 plans are contracted state
by state, so the Ohio plan and the Connecticut plan are separate negotiations
with separate results. "The Blue Cross rate for 99213" has no answer. Neither,
really, does "the BCBS Texas rate". Your rate is the one in your contract.

## Which Blue plan is yours

In most states there is one Blue plan and the question answers itself. In a few
there are two or more, split by geography or by line of business, and it
matters which one your contract is with:

| State | The Blue plans |
|---|---|
| California | [Anthem Blue Cross](/payers/anthem-ca) and Blue Shield of California |
| Missouri and Kansas | [Anthem BCBS Missouri](/payers/anthem-mo), except the Kansas City area, where [Blue KC](/payers/bcbskc) operates on both sides of the state line; BCBS of Kansas for the rest of Kansas |
| New York | [Empire (Anthem)](/payers/anthem-ny) in the New York City area and parts of upstate, [Excellus](/payers/excellus) upstate, [Highmark Western New York](/payers/highmark-wny) and [Highmark Northeastern New York](/payers/highmark-neny) |
| Pennsylvania | [Highmark BCBS](/payers/highmark-pa) and [Highmark Blue Shield](/payers/highmark-bs-pa), Capital Blue Cross and Independence Blue Cross, by region |
| Idaho | [Blue Cross of Idaho](/payers/bcidaho) and [Regence BlueShield of Idaho](/payers/regence-id) |
| Washington | [Premera Blue Cross](/payers/premera) and [Regence BlueShield](/payers/regence-wa) |
| Virginia, Maryland, DC | [Anthem BCBS Virginia](/payers/anthem-va) for most of Virginia; [CareFirst](/payers/carefirst) for Maryland, DC and the Northern Virginia suburbs |

Where two plans overlap, practices are frequently contracted with both, and the
two contracts rarely pay the same.

## BlueCard: why an out-of-state patient pays your local rate

This is the part most practices get wrong, and it is the reason your local
plan's fee schedule matters more than any other Blue's.

When a patient with a Blue card from another state is seen by your practice,
the claim goes through the **BlueCard** program. You file it with your local
Blue plan — the *host* plan. The host plan prices the claim according to the
terms of **its** contract with you, and the patient's *home* plan pays it. The
Blue plans' own provider FAQs are explicit on the second half: you may not bill
that out-of-area member for the difference between your charge and the locally
negotiated allowance.

Some programs carry their own rules, so your local plan's provider manual has
the final word. But for an ordinary commercial BlueCard claim, a Michigan
practice seeing a patient insured by Blue
Cross of Idaho is paid off its Blue Cross Blue Shield of Michigan contract, not
anything Idaho negotiated. So for those claims, the Idaho plan's fee schedule
is irrelevant to you, and yours is the whole story.

Two consequences worth acting on:

- **An underpayment on a BlueCard claim is a question for your local plan.** It priced the claim.
- **Your local Blue contract is carrying more volume than your member counts suggest**, because it prices every out-of-area Blue visit too. That is leverage worth knowing about before a renegotiation.

## How to find your Blue plan’s rate

**1. Name the plan and the network.** "BCBS" is not specific enough, and
neither is the plan alone: most Blue plans publish separate rates for PPO, HMO
and other products. Your contract, your remits and your patients' cards all
name the network. Write it down.

**2. Ask the plan for its fee schedule for your codes.** The method that works
is in our guide to [finding your contracted rate for any CPT
code](/blog/find-your-contracted-rate): in writing, with your TIN, the network,
a list of your top 25 codes, and a request for the effective date.

**3. Read the plan's published file.** Blue plans are health insurance issuers —
and administrators for self-funded employer plans — covered by the
Transparency in Coverage rules, so each publishes an
in-network rate file, updated monthly, listing negotiated rates by billing code
and by provider NPI and TIN. Many Blue plans host these files on shared Blue
infrastructure, which makes them look like one dataset. They are not: each
plan's table of contents points at its own files, for its own networks.

**4. Check the arrangement before you trust the number.** In the file, each rate
carries a `negotiation_arrangement`. If a network is `capitation`, there is
no per-code dollar to find — the plan pays a per-member amount instead — and a
lookup that returns nothing is correct, not broken. We saw exactly this with
capitated HMO networks at BCBS Illinois. Also check `negotiated_type`: a rate
marked `derived` is the plan's own estimate, not your contract.

## The honest limit

The published files show what each Blue plan negotiated with your NPI. They do
not tell you which plan's members you will see next year, how a plan will
respond to a request for an increase, or anything about Medicare Advantage or
Medicaid plans a Blue company may also run — those sit under different rules.
And not every Blue plan is available on RateBench yet; our [payers
page](/payers) lists the ones that are.

---

*RateBench reads the published files for the Blue plans in [every state we
cover](/payers) and returns the negotiated rate for your own NPI, with the
network and a link to the source file. A single [rate lookup is free](/#check).
A [fee schedule](/features/fee-schedule) that puts the Blue plans and other
payers you take side by side is on a [paid plan](/pricing).*

## Common questions

### Is there one Blue Cross Blue Shield fee schedule?

No. Blue Cross Blue Shield is a brand licensed by the Blue Cross Blue Shield Association to independent, locally operated companies — more than 30 of them. Each contracts with providers separately and sets its own rates, and each publishes its own negotiated rates under the federal Transparency in Coverage rules.

### What rate am I paid when a patient has a Blue plan from another state?

Under the BlueCard program, the claim is filed with and priced by your local Blue plan — the "host" plan — according to its contract with you. The patient’s "home" plan pays it. So an out-of-state Blue member is normally paid at your local Blue plan’s rate, and you cannot bill that member the difference between your charge and the locally negotiated allowance.

### Does the same parent company pay the same rate in every state?

No. Elevance Health operates Anthem Blue Cross or Anthem Blue Cross and Blue Shield in 14 states, but contracts and rates are set state by state and network by network, and each plan publishes its own. Even across different Blue companies the typical rate differs a lot: in September 2026 files the typical 99213 was $61.95 at BCBS Texas and $92.08 at BCBS Mississippi.

### Why does my Blue plan publish no dollar rate for my practice?

The most common reason is that the network is capitated or otherwise not paid per code — the published file marks that with a negotiation arrangement of "capitation" and there is no per-code dollar to show. The other common reasons are that you are contracted under a different network or product than the one you searched, or that your rates are filed under a group NPI or TIN.

## Sources

1. Blue Cross Blue Shield Association (accessed September 2026). "Local Blue Cross and Blue Shield companies and licensees". https://www.bcbs.com/about-us/blue-cross-blue-shield-system/state-health-plan-companies
2. Becker’s Payer Issues (updated April 2025). "101 things to know about Blue Cross Blue Shield". https://www.beckerspayer.com/payer/100-things-to-know-about-blue-cross-blue-shield/
3. Elevance Health / U.S. SEC (2026). "Form 10-Q for the quarter ended June 30, 2026". https://www.sec.gov/Archives/edgar/data/0001156039/000115603926000060/elv-20260630.htm
4. Health Care Service Corporation (accessed September 2026). "About HCSC". https://www.hcsc.com/
5. Highmark. "BlueCard Program: answers to frequently asked questions". https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/provider-network/inter-plan-programs/bluecard-faqs.pdf
6. Excellus BlueCross BlueShield. "The BlueCard Program FAQ for providers". https://provider.excellusbcbs.com/resources/bluecard-faq
7. Federal Register / U.S. Departments of the Treasury, Labor and HHS (November 12, 2020). "Transparency in Coverage, final rules (85 FR 72158)". https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage
8. CMS (accessed September 2026). "price-transparency-guide: in-network rates schema". https://github.com/CMSgov/price-transparency-guide