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What Insurers Pay: Excellus BlueCross BlueShield

The price Excellus BlueCross BlueShield has already agreed to pay each doctor, for the same procedure, summarised by state. Prices for one procedure can differ several-fold between two practices a few miles apart.

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93procedures mapped
3,587zip codes
54states
462,594providers
2026-10-01prices as of

What this data is

Since 2021, a federal rule called Transparency in Coverage has required health insurers to publish, every month, the rate they have negotiated with every provider in their network, for every billing code. Not an average, not a range — the actual contracted price, provider by provider.

The catch is that nobody can read them. They are published as raw JSON files running to gigabytes each, one per network, with providers referenced by numeric id rather than by name. They satisfy the rule without being of the slightest use to a patient. These maps are built directly from those files: every number here was published by the insurer, and nothing is estimated, modelled, or averaged from a survey.

How this was built

Excellus BlueCross BlueShield publishes its files at its price transparency page. From there this build read 121 index files naming 2,331 health plans (2,311 group-market, 20 individual-market), then downloaded 2734 in-network rate files (2.3 GB) on 2026-09-27.

From those, 306,446 price entries for 93 common procedures were extracted, each provider looked up in the federal NPPES registry for their practice address, and the results grouped by zip code.

That is a count of entries, not of prices. An entry is one price together with the list of providers it applies to, and insurers write their files very differently: some state a price once for a whole network, others repeat it for every practice. Here a typical Excellus BlueCross BlueShield entry applies to 109 providers (3,108 on average), so the 306,446 entries come to about 952 million provider-level prices (counting each network file separately). A big or small entry count says how an insurer writes its files, not how many prices it has — compare insurers on the maps, not on this number.

The 121 index files this was built from

Check it yourself

Everything here is public and verifiable:

What the price means

Each price is what this insurer pays that provider for that billing code — the price in the setting where that procedure is normally done: an office visit in an office, an emergency visit in the emergency department, a hospital stay as an inpatient, a colonoscopy at a surgery center or hospital outpatient department. Procedures done everywhere, such as lab tests and scans, show every in-person setting. Telehealth rates are excluded, and so are prices for only part of a service: a scan's reading fee or equipment fee alone, an assistant surgeon's fee, a procedure that was not completed. Each procedure below, and each map, says which setting it shows.

It is not what you will be billed. What you pay depends on your deductible, copay and coinsurance; a visit usually includes more than one billing code; and a hospital-based practice may add a facility fee. Use these maps to compare providers, not to predict a bill.

“x Medicare” compares each price with what original Medicare pays a doctor for the same service in the same state under its physician fee schedule (RVU26D, in force from 2026-10-01). Insurers write their contracts as a share of Medicare, so 1.3x means the insurer pays 30% more than Medicare would; Medicare Advantage plans generally pay close to 1.0x. Across the 85 procedures below that Medicare prices, Excellus BlueCross BlueShield’s typical price is 0.9x Medicare; each procedure shows its own figure, and each map shows it state by state. Lab tests are compared with Medicare’s lab fee schedule and hospital stays with what Medicare paid hospitals in the state per stay; each map says which.

Doctor’s fee or facility fee?

Care in a hospital or surgery center usually comes as two separate bills: the doctor’s fee (the “professional” fee, for the doctor’s own work) and the facility fee (the hospital or surgery center’s charge for the room, nurses and equipment). The facility fee is often the larger of the two, and many people do not know it is coming. A visit to an independent doctor’s office normally has no facility fee, but a clinic owned by a hospital may add one.

Insurers publish the two separately. Every procedure below, and every map, says which one it shows: here 7 show doctor's fee, 24 show facility fee, 62 show a mix of both.

A whole visit, not one code

A visit is billed as several codes, each priced on its own. An emergency visit for chest pain is the visit code twice over (the doctor’s fee and the hospital’s facility fee), then blood tests, an EKG and a chest X-ray — and the tests vary more between hospitals than the visit code does. These are the typical totals Excellus BlueCross BlueShield would pay in its largest states, adding up the median of each part; a part the files do not price there is left out and named.

Who is counted

Excellus BlueCross BlueShield lists clinicians individually: 89% of the 462,594 provider IDs (NPIs) it names are individual doctors, nurse practitioners and therapists; the rest are practices, clinics and hospitals. “Providers” counts those IDs. For each procedure, “providers” counts the clinicians whose specialty performs it, plus practices, clinics and hospitals. Insurers attach their whole fee schedule to every contracted provider, so their files name far more — family doctors and nurse practitioners listed at a price for a brain scan they will never do — and each map says how many were named.

What this data may be missing

Some prices this insurer’s members pay are published somewhere else, so they are not on these maps:

How the files read

Excellus BlueCross BlueShield’s 121 index files name 2,734 in-network rate files (dated 2026-10-01). 2,734 were downloaded and 2,734 read — every one. 384 files held no prices for the procedures mapped here.

What is not here

These maps summarise a whole state. Prices vary far more between two practices in one town than between two states, so a statewide median tells you what a procedure broadly costs, not what any particular provider charges. Zip-code and provider-level detail is not published here, but this data can be requested.

One insurer, one month, and only commercial plans — the rules do not cover Medicaid or Medicare Advantage, so those prices are not published at all. Out-of-network allowed amounts are published separately and are not included. Providers are placed at the practice address they registered with the federal NPI registry, which is sometimes a billing office rather than where they actually see patients.

What a Map Looks Like

Every state is a circle, shaded by what that procedure typically costs there and sized by how many providers report a price. Click one for the lowest, typical and highest price in that state, and the middle half of the range - the spread matters more than the median.

Cheaper Pricier Ohio 4,120 providers Lowest $84 Typical $102 Highest $186 Providers at each price
Illustration. Open the real office visit, existing patient (standard) map — 88 KB.

Pick a Procedure

Cancer screening

Digestive procedures

Emergency & hospital

Eye care

Heart tests

Home health

Imaging & scans

Labs & bloodwork

Mental health

Office visits

Preventive & wellness

Sleep

Spine & pain injections

Surgery & procedures

Therapy & rehab

Women's health & maternity

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Corrections are welcome — these prices come straight from insurers' and hospitals' own files, and if one looks wrong it is worth knowing about.

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