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Start free trialRegional Payer (Pennsylvania)Blue Cross Blue Shield (BCBS) family
Payer price transparency data
Capital Blue Cross
Capital Blue Cross is a regional (Pennsylvania) health insurer, part of the Blue Cross Blue Shield (BCBS) family. They report 5.8K insurance plans covering 49K providers across 51K billing codes.
Source: public Transparency in Coverage filesRefreshed monthly, latest September 202619 monthly releases tracked
Monthly release
5.8K
Plans
49K
Providers (NPIs)
XX% vs prior month
48K
Tax IDs
XX% vs prior month
51K
Billing codes
4.6M
Rate rows
XX% vs prior month
September 2026 release
What's in Capital Blue Cross's data
A profile of the machine-readable files Capital Blue Cross publishes, after PayerPrice parses and normalizes them.
Billing code types
Distinct codes and rate rows by code system
CodesRows
- HCPCS36K4M89%
- CPT12K500K11%
- CDT1.5K7.7K0.2%
- MS-DRG7701.8K<0.1%
- RC460390<0.1%
Billing class
Professional vs. institutional rate rows
- Professional4.5M100%
- Institutional13K0.3%
Negotiation arrangement
How each rate is expressed
- Fee Schedule4.4M97%
- Negotiated140K3.2%
- Percentage1.9K<0.1%
- Per Diem1K<0.1%
Plan identifiers
HIOS IDs mark individual and small-group plans; EINs mark employer plans
- EIN5.8K100%
Providers by type
Distinct NPIs by entity type
- Individual (Type 1)44K91%
- Organization (Type 2)4.5K9.2%
Tax IDs by type
How provider groups are identified
- NPI (Individual)44K92%
- EIN3.6K7.6%
- NPI (Organization)8<0.1%
Top states
States with the most providers in network
- Pennsylvania41K
- New Jersey1.2K
- New York740
- Maryland660
- Florida570
- California360
Top specialties
Provider taxonomies with the most NPIs
- Physician Assistant3K
- Professional Counselor2.8K
- Clinical Social Worker2.5K
- Family Medicine Physician2.4K
- Physical Therapist2.1K
- Family Nurse Practitioner1.9K
These are the files. Want the rates inside them?
Look up Capital Blue Cross's negotiated rates by provider, TIN, billing code and plan.
Month-over-month history
Track how network size and rate volume change with each monthly release.
| Month | Plans | NPIs | Tax IDs | Billing codes | Rate rows |
|---|---|---|---|---|---|
| September 2026 | 5.8K | 49K | 48K | 51K | 4.6M |
| August 2026 | 5.8K | 48K | 47K | 51K | 6.7M |
| July 2026 | 18K | 48K | 47K | 51K | 5M |
| June 2026 | — | — | — | — | |
| May 2026 | — | — | — | — |
Data quality scorecard
4/6Acceptable
This payer scores 4/6 on data quality (Acceptable). Areas that don't meet the threshold: valid tax ids and hios plan.
Evaluated on the September 2026 release.
Professional & Institutional Rates
Data includes both professional and institutional billing class rates
Valid Tax IDs
Less than 80% of Tax IDs are EIN or NPI (Organization) type
HIOS Plan
Data does not include any HIOS-identified plans
Low Derived/Percentage Rates
Less than 10% of negotiation entries are derived or percentage type
Standard Code Coverage
Sufficient CPT and HCPCS code coverage with low proportion of LOCAL entries
Common Taxonomies
NPIs in the dataset cover at least 50 distinct provider taxonomies
How the score works
Each monthly release is checked against six criteria. 5–6 passing criteria rate Good, 3–4 rate Acceptable, and 0–2 rate Poor.
Behavioral, RX, and other specialty networks may not pass all criteria but can still contain complete and usable data.
Access the data
Capital Blue Cross's negotiated rates, in the tools your team already uses
PayerPrice turns raw transparency files into one clean, normalized dataset across 180+ payers, refreshed every month. Pick how you want to work with it.
API
REST API
Pull negotiated rates, providers and benchmarks into your own products and pipelines.
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Snowflake & Databricks
Query the full normalized dataset with SQL or PySpark, shared directly into your warehouse.
See data sharingAI
MCP server
Ask Claude, Cursor or your own agents questions like "What does Capital Blue Cross pay for CPT 99213 near me?"
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Frequently asked questions
About Capital Blue Cross's price transparency data.
What price transparency data does Capital Blue Cross publish?
Capital Blue Cross's September 2026 Transparency in Coverage files list 5.8K plans, 49K providers (NPIs), 48K tax IDs and 51K billing codes, for 4.6M negotiated rate rows in total.
Which states does Capital Blue Cross's network cover?
Capital Blue Cross's files include providers in 51 states. The states with the most in-network providers are Pennsylvania, New Jersey, New York, Maryland, Florida.
How often is Capital Blue Cross's data updated?
Payers must post updated machine-readable files every month. PayerPrice processes Capital Blue Cross's files monthly; the latest processed release is September 2026, and 19 monthly releases are available.
What is the Transparency in Coverage rule?
Since July 2022, the federal Transparency in Coverage rule has required most group health plans and health insurers to publish machine-readable files of their in-network negotiated rates and out-of-network allowed amounts, updated monthly. These files are the source for the data on this page.
How can I access Capital Blue Cross's negotiated rates?
Start a free PayerPrice trial to search Capital Blue Cross's rates in the web app, or book a demo to get the full dataset through the REST API, SQL in Snowflake or Databricks, or AI assistants through the PayerPrice MCP server.