Aetna · Idaho · commercial in-network

Aetna negotiated rates in Idaho

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

Aetna in Idaho at a glance

Across 227 procedure codes for 8 specialties
Rate index vs state market
112
12% above the Idaho median
Rank in state
1 of 4
Aetna 112 · BCBS 107 · UHC 98 · Cigna 97
vs own national
152
Aetna's level vs its national median
Codes where highest
38%
of 227 codes
491 sampled providers381 TINs227 codesMedian 198% of Medicare · method

What the data shows

Generated from Idaho and Aetna data only
1

Aetna ranks 1st of 4 payers in Idaho with a rate index of 112 (100 = the Idaho market median), across 227 procedure codes.

2

Aetna has the highest median for only 38% of codes in Idaho; Aetna leads with an index of 112 in the files analyzed.

3

Aetna's Idaho rates sit 52% above its own national level, the 2nd highest of its 51 states.

4

Largest premium over the Idaho market: CPT 88312 (Special stains group 1) at 232% of market; largest discount: CPT 99457 (Rpm tx mgmt 1st 20 min) at 69%.

How the four payers compare in Idaho

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
Aetna1121
112
38%491
Blue Cross Blue Shield1072
107
25%547
UnitedHealthcare983
98
27%546
Cigna974
97
10%529

Where Aetna pays most and least against the Idaho market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88312
Special stains group 1
$200$86+132%59
88313
Special stains group 2
$142$61+131%30
88342
Imhchem/imcytchm 1st antb
$180$81+122%33
88305
Tissue exam by pathologist
$129$64+103%64
36465
Njx noncmpnd sclrsnt 1 vein
$356$185+92%31
37243
Vasc embolize/occlude organ
$1,721$897+92%83
36482
Endoven ther chem adhes 1st
$536$310+73%25
33208
Insrt heart pm atrial & vent
$1,551$908+71%46

Furthest below market

CodeAetnaMarketGapProv.
99457
Rpm tx mgmt 1st 20 min
$39$57-31%55
75574
Ct angio hrt w/3d image
$441$581-24%43
99454
Rem mntr physiol param 16-30
$65$85-24%55
99497
Advncd care plan 30 min
$97$125-22%57
91110
Gi trc img intral esoph-ile
$1,038$1,302-20%38
99350
Home/res vst est high mdm 60
$220$275-20%28
99348
Home/res vst est low mdm 30
$103$128-19%28
99349
Home/res vst est mod mdm 40
$158$195-19%46

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 Idaho?

Aetna ranks 1st of 4 in Idaho with an index of 112. It is highest on 38% of codes.

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

About 52% above.

Which procedure does Aetna pay most above market in Idaho?

CPT 88312 (Special stains group 1), at 232% of the Idaho 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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