Aetna · payer overview
Aetna negotiated rates by state and specialty
Where Aetna pays above and below the market, from its published in-network files.
Aetna at a glance
228 codes · 51 states · 27,689 sampled providers · source: Aetna commercial plans
Rate index
81
100 = four-payer median
Payer rank
4 of 4
1 = highest
Median % of Medicare
125%
across tracked codes
Highest on
0%
of codes
What the data shows
1
Aetna ranks 4th of 4 payers with a rate index of 81 (100 = four-payer median) across 228 procedure codes.
2
Its median rate is 125% of Medicare, and it has the highest median on 0% of codes in the files analyzed.
3
Strongest market: Montana (index 123 vs that state's market); weakest: Wisconsin (51).
4
Largest premium over the market: CPT 88313 (Special stains group 2) at 111% of market.
5
By specialty it is strongest for ophthalmology (ranks 4th of 4 payers).
Aetna by state
Index vs the state market; own-national index vs the payer's national level
| State | Index vs market | Rank in state | vs own national | Level | Providers |
|---|---|---|---|---|---|
| Montana | 123 | 1 of 4 | 136 | 80 | |
| Alaska | 121 | 1 of 4 | 306 | 211 | |
| Idaho | 112 | 1 of 4 | 152 | 491 | |
| District of Columbia | 102 | 3 of 4 | 126 | 357 | |
| Maryland | 101 | 3 of 4 | 106 | 645 | |
| Mississippi | 100 | 2 of 4 | 138 | 608 | |
| Alabama | 100 | 1 of 4 | 111 | 847 | |
| Hawaii | 97 | 4 of 4 | 111 | 114 | |
| Louisiana | 96 | 2 of 4 | 106 | 832 | |
| Texas | 95 | 3 of 4 | 93 | 764 | |
| New Mexico | 94 | 3 of 4 | 107 | 406 | |
| Virginia | 93 | 3 of 4 | 102 | 752 | |
| Michigan | 92 | 4 of 4 | 100 | 707 | |
| Washington | 91 | 4 of 4 | 142 | 708 | |
| Arizona | 91 | 3 of 4 | 88 | 719 | |
| Utah | 90 | 4 of 4 | 109 | 418 | |
| Illinois | 88 | 3 of 4 | 105 | 626 | |
| Oklahoma | 88 | 4 of 4 | 86 | 638 | |
| Ohio | 88 | 4 of 4 | 101 | 711 | |
| Nevada | 87 | 4 of 4 | 90 | 615 | |
| Rhode Island | 87 | 4 of 4 | 103 | 422 | |
| Delaware | 87 | 4 of 4 | 91 | 349 | |
| Arkansas | 86 | 3 of 4 | 98 | 549 | |
| Florida | 85 | 4 of 4 | 82 | 758 | |
| Maine | 85 | 4 of 4 | 103 | 552 | |
| Kansas | 85 | 4 of 4 | 98 | 475 | |
| California | 84 | 4 of 4 | 97 | 566 | |
| Georgia | 83 | 4 of 4 | 130 | 755 | |
| New York | 83 | 4 of 4 | 90 | 755 | |
| Kentucky | 82 | 4 of 4 | 89 | 681 | |
| New Jersey | 82 | 4 of 4 | 100 | 807 | |
| Colorado | 82 | 4 of 4 | 105 | 717 | |
| Tennessee | 82 | 4 of 4 | 100 | 767 | |
| Missouri | 82 | 4 of 4 | 92 | 630 | |
| Pennsylvania | 82 | 4 of 4 | 95 | 679 | |
| Connecticut | 79 | 4 of 4 | 116 | 754 | |
| Indiana | 78 | 4 of 4 | 80 | 698 | |
| West Virginia | 76 | 4 of 4 | 86 | 329 | |
| South Carolina | 76 | 4 of 4 | 87 | 627 | |
| Vermont | 74 | 4 of 4 | 94 | 279 | |
| Oregon | 71 | 4 of 4 | 126 | 494 | |
| Nebraska | 65 | 4 of 4 | 100 | 226 | |
| Wyoming | 65 | 4 of 4 | 101 | 71 | |
| New Hampshire | 64 | 4 of 4 | 98 | 619 | |
| North Carolina | 64 | 4 of 4 | 90 | 568 | |
| Iowa | 64 | 4 of 4 | 98 | 295 | |
| Massachusetts | 62 | 4 of 4 | 95 | 595 | |
| Minnesota | 55 | 4 of 4 | 84 | 774 | |
| North Dakota | 54 | 4 of 4 | 85 | 211 | |
| South Dakota | 51 | 4 of 4 | 82 | 147 | |
| Wisconsin | 51 | 4 of 4 | 98 | 291 |
Aetna by specialty
Index vs the four-payer median for the specialty's codes
| Specialty | Index | Rank of 4 | Highest on | Providers |
|---|---|---|---|---|
| Ophthalmology | 88 | 4 of 4 | 0% | 3,503 |
| Cardiology | 78 | 4 of 4 | 0% | 3,605 |
| Gastroenterology | 78 | 4 of 4 | 0% | 3,286 |
| Orthopedic surgery | 82 | 4 of 4 | 0% | 3,440 |
| Internal medicine | 73 | 4 of 4 | 0% | 3,442 |
| Urology | 76 | 4 of 4 | 0% | 3,107 |
| Diagnostic radiology | 83 | 4 of 4 | 0% | 4,057 |
| Dermatology | 81 | 4 of 4 | 0% | 3,249 |
Where Aetna pays most and least against the market
Highest above market
| Code | Aetna | vs market |
|---|---|---|
| 88313 Special stains group 2 | $79 | +11% |
| 88312 Special stains group 1 | $107 | +10% |
| 88305 Tissue exam by pathologist | $72 | +3% |
| 72141 Mri neck spine w/o dye | $400 | +3% |
| 72148 Mri lumbar spine w/o dye | $386 | +1% |
| 73221 Mri joint upr extrem w/o dye | $402 | +1% |
| 73721 Mri jnt of lwr extre w/o dye | $402 | +1% |
| 88342 Imhchem/imcytchm 1st antb | $96 | +1% |
Furthest below market
| Code | Aetna | vs market |
|---|---|---|
| 99457 Rpm tx mgmt 1st 20 min | $31 | -41% |
| 99350 Home/res vst est high mdm 60 | $157 | -37% |
| 99426 Prin care mgmt staff 1st 30 | $49 | -36% |
| 99349 Home/res vst est mod mdm 40 | $113 | -35% |
| 52224 Cystoscopy and treatment | $297 | -35% |
| 64566 Neuroeltrd stim post tibial | $45 | -35% |
| 11102 Tangntl bx skin single les | $43 | -34% |
| 51702 Insert temp bladder cath | $40 | -34% |
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 Aetna contract at market?
Compare your negotiated rates with these medians by state and specialty.