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
StateIndex vs marketRank in statevs own nationalLevelProviders
Montana1231 of 4136
80
Alaska1211 of 4306
211
Idaho1121 of 4152
491
District of Columbia1023 of 4126
357
Maryland1013 of 4106
645
Mississippi1002 of 4138
608
Alabama1001 of 4111
847
Hawaii974 of 4111
114
Louisiana962 of 4106
832
Texas953 of 493
764
New Mexico943 of 4107
406
Virginia933 of 4102
752
Michigan924 of 4100
707
Washington914 of 4142
708
Arizona913 of 488
719
Utah904 of 4109
418
Illinois883 of 4105
626
Oklahoma884 of 486
638
Ohio884 of 4101
711
Nevada874 of 490
615
Rhode Island874 of 4103
422
Delaware874 of 491
349
Arkansas863 of 498
549
Florida854 of 482
758
Maine854 of 4103
552
Kansas854 of 498
475
California844 of 497
566
Georgia834 of 4130
755
New York834 of 490
755
Kentucky824 of 489
681
New Jersey824 of 4100
807
Colorado824 of 4105
717
Tennessee824 of 4100
767
Missouri824 of 492
630
Pennsylvania824 of 495
679
Connecticut794 of 4116
754
Indiana784 of 480
698
West Virginia764 of 486
329
South Carolina764 of 487
627
Vermont744 of 494
279
Oregon714 of 4126
494
Nebraska654 of 4100
226
Wyoming654 of 4101
71
New Hampshire644 of 498
619
North Carolina644 of 490
568
Iowa644 of 498
295
Massachusetts624 of 495
595
Minnesota554 of 484
774
North Dakota544 of 485
211
South Dakota514 of 482
147
Wisconsin514 of 498
291

Aetna by specialty

Index vs the four-payer median for the specialty's codes
SpecialtyIndexRank of 4Highest onProviders
Ophthalmology884 of 40%3,503
Cardiology784 of 40%3,605
Gastroenterology784 of 40%3,286
Orthopedic surgery824 of 40%3,440
Internal medicine734 of 40%3,442
Urology764 of 40%3,107
Diagnostic radiology834 of 40%4,057
Dermatology814 of 40%3,249

Where Aetna pays most and least against the market

Highest above market

CodeAetnavs 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

CodeAetnavs 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.

Request a rate benchmark