Highmark BCBS PPO OON Allowed Amounts as a Percent of In-Network Rates, February 2026

Highmark reports OON historical OON allowed amounts higher than (>100%) in-network rates for many services.

For Highmark BCBS PPO, we compare out-of-network (OON) allowed amounts to in-network negotiated rates at the billing-code level. For each billing class and service line, we compute code-level medians for OON allowed amounts from the February 2026 OON file and in-network negotiated rates from the corresponding in-network rates data, then restrict to codes with at least 10 distinct EINs observed on both the OON and in-network sides. Service-line percentages report the average across included codes (median OON allowed divided by median in-network rate), expressed as a percent.
Source: Serif HealthGet the dataCreated with Datawrapper