Aetna · California · commercial in-network

Aetna negotiated rates in California

How Aetna's California rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.

Aetna in California at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
84
16% below the California median
Rank in state
4 of 4
UHC 126 · Cigna 112 · BCBS 96 · Aetna 84
vs own national
97
Aetna's level vs its national median
Codes where highest
2%
of 228 codes
566 sampled providers796 TINs228 codesMedian 115% of Medicare · method

What the data shows

Generated from California and Aetna data only
1

Aetna ranks 4th of 4 payers in California with a rate index of 84 (100 = the California market median), across 228 procedure codes.

2

Aetna has the highest median for only 2% of codes in California; UnitedHealthcare leads with an index of 126 in the files analyzed.

3

Aetna's California rates sit 3% below its own national level, the 32nd highest of its 51 states.

4

Largest premium over the California market: CPT 88342 (Imhchem/imcytchm 1st antb) at 113% of market; largest discount: CPT 51702 (Insert temp bladder cath) at 45%.

How the four payers compare in California

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1261
126
58%658
Cigna1122
112
34%648
Blue Cross Blue Shield963
96
6%807
Aetna844
84
2%566

Where Aetna pays most and least against the California market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88342
Imhchem/imcytchm 1st antb
$113$100+13%76
72148
Mri lumbar spine w/o dye
$475$421+13%133
88312
Special stains group 1
$118$107+11%148
92235
Fluorescein angrph mltiframe
$147$134+10%80
92083
Extended visual field xm
$88$82+8%83
73721
Mri jnt of lwr extre w/o dye
$475$443+7%133
88305
Tissue exam by pathologist
$107$100+7%149
73221
Mri joint upr extrem w/o dye
$475$445+7%133

Furthest below market

CodeAetnaMarketGapProv.
51702
Insert temp bladder cath
$36$79-55%57
52648
Laser surgery of prostate
$813$1,748-54%45
64566
Neuroeltrd stim post tibial
$34$74-53%55
52224
Cystoscopy and treatment
$217$440-51%53
52332
Cystoscopy and treatment
$198$374-47%57
99426
Prin care mgmt staff 1st 30
$49$89-45%49
11104
Punch bx skin single lesion
$55$96-43%73
11102
Tangntl bx skin single les
$44$77-43%73

Where Aetna pays above and below its national level

Index vs the payer's own national median (100 = national)

Highest states

StateIndexProv.
Alaska306
211
Idaho152
491
Washington142
708
Mississippi138
608
Montana136
80

Lowest states

StateIndexProv.
Indiana80
698
South Dakota82
147
Florida82
758
Minnesota84
774
North Dakota85
211

Frequently asked questions

Does Aetna pay more or less than the other payers in California?

Aetna ranks 4th of 4 in California with an index of 84. It is highest on 2% of codes.

Are Aetna's California rates above or below its national level?

About 3% below.

Which procedure does Aetna pay most above market in California?

CPT 88342 (Imhchem/imcytchm 1st antb), at 113% of the California median.

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.

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