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
What the data shows
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.
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.
Aetna's District of Columbia rates sit 26% above its own national level, the 7th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 142 | 1 | 59% | 396 | |
| Cigna | 121 | 2 | 19% | 430 | |
| Aetna | 102 | 3 | 21% | 357 | |
| Blue Cross Blue Shield | 66 | 4 | 1% | 484 |
Where Aetna pays most and least against the District of Columbia market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
Highest states
| State | Index | Prov. | |
|---|---|---|---|
| Alaska | 306 | 211 | |
| Idaho | 152 | 491 | |
| Washington | 142 | 708 | |
| Mississippi | 138 | 608 | |
| Montana | 136 | 80 |
Lowest states
| State | Index | Prov. | |
|---|---|---|---|
| Indiana | 80 | 698 | |
| South Dakota | 82 | 147 | |
| Florida | 82 | 758 | |
| Minnesota | 84 | 774 | |
| North Dakota | 85 | 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
- 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 in District of Columbia?
Compare your negotiated rates for these codes with District of Columbia medians for each payer.