Aetna · District of Columbia · commercial in-network

Aetna negotiated rates in District of Columbia

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

Aetna in District of Columbia at a glance

Across 226 procedure codes for 8 specialties
Rate index vs state market
102
2% above the District of Columbia median
Rank in state
3 of 4
UHC 142 · Cigna 121 · Aetna 102 · BCBS 66
vs own national
126
Aetna's level vs its national median
Codes where highest
21%
of 226 codes
357 sampled providers317 TINs226 codesMedian 160% of Medicare · method

What the data shows

Generated from District of Columbia and Aetna data only
1

Aetna ranks 3rd of 4 payers in District of Columbia with a rate index of 102 (100 = the District of Columbia market median), across 226 procedure codes.

2

Aetna has the highest median for only 21% of codes in District of Columbia; UnitedHealthcare leads with an index of 142 in the files analyzed.

3

Aetna's District of Columbia rates sit 26% above its own national level, the 7th highest of its 51 states.

4

Largest premium over the District of Columbia market: CPT 88313 (Special stains group 2) at 182% of market; largest discount: CPT 92014 (Compre oph exam est pt 1/>) at 61%.

How the four payers compare in District of Columbia

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1421
142
59%396
Cigna1212
121
19%430
Aetna1023
102
21%357
Blue Cross Blue Shield664
66
1%484

Where Aetna pays most and least against the District of Columbia market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88313
Special stains group 2
$135$74+82%39
90960
Esrd srv 4 visits p mo 20+
$797$460+73%38
99490
Chrnc care mgmt staff 1st 20
$128$77+66%140
73560
X-ray exam of knee 1 or 2
$80$53+52%27
73610
X-ray exam of ankle
$87$57+52%27
73630
X-ray exam of foot
$80$53+52%27
73030
X-ray exam of shoulder
$81$53+52%27
72110
X-ray exam l-2 spine 4/>vws
$120$79+52%26

Furthest below market

CodeAetnaMarketGapProv.
92014
Compre oph exam est pt 1/>
$55$90-39%38
99487
Cplx chrnc care 1st 60 min
$86$130-34%21
77080
Dxa bone density axial
$52$75-30%84
92004
Compre oph exam new pt 1/>
$75$106-30%38
72197
Mri pelvis w/o & w/dye
$505$680-26%85
74183
Mri abd w/o cntr flwd cntr
$507$680-25%83
99215
Office o/p est hi 40 min
$172$224-23%341
99213
Office o/p est low 20 min
$83$107-22%343

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 District of Columbia?

Aetna ranks 3rd of 4 in District of Columbia with an index of 102. It is highest on 21% of codes.

Are Aetna's District of Columbia rates above or below its national level?

About 26% above.

Which procedure does Aetna pay most above market in District of Columbia?

CPT 88313 (Special stains group 2), at 182% of the District of Columbia 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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