Aetna negotiated rates in Illinois
How Aetna's Illinois rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Aetna in Illinois at a glance
What the data shows
Aetna ranks 3rd of 4 payers in Illinois with a rate index of 88 (100 = the Illinois market median), across 228 procedure codes.
Aetna has the highest median for only 1% of codes in Illinois; UnitedHealthcare leads with an index of 133 in the files analyzed.
Aetna's Illinois rates sit 5% above its own national level, the 16th highest of its 51 states.
Largest premium over the Illinois market: CPT 88342 (Imhchem/imcytchm 1st antb) at 144% of market; largest discount: CPT 99457 (Rpm tx mgmt 1st 20 min) at 55%.
How the four payers compare in Illinois
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 133 | 1 | 86% | 706 | |
| Cigna | 106 | 2 | 8% | 644 | |
| Aetna | 88 | 3 | 1% | 626 | |
| Blue Cross Blue Shield | 86 | 4 | 5% | 841 |
Where Aetna pays most and least against the Illinois market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 88342 Imhchem/imcytchm 1st antb | $123 | $86 | +44% | 75 |
| 88312 Special stains group 1 | $121 | $94 | +29% | 141 |
| 33208 Insrt heart pm atrial & vent | $946 | $798 | +19% | 74 |
| 93308 Tte f-up or lmtd | $165 | $141 | +18% | 80 |
| 77280 Ther rad simulaj field smpl | $312 | $266 | +17% | 68 |
| 93312 Echo transesophageal | $407 | $348 | +17% | 80 |
| 93351 Stress tte complete | $400 | $343 | +17% | 74 |
| 93280 Pm device progr eval dual | $115 | $101 | +15% | 73 |
Furthest below market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 99457 Rpm tx mgmt 1st 20 min | $27 | $49 | -45% | 72 |
| 99348 Home/res vst est low mdm 30 | $68 | $106 | -36% | 52 |
| 99350 Home/res vst est high mdm 60 | $168 | $259 | -35% | 39 |
| 99349 Home/res vst est mod mdm 40 | $115 | $177 | -35% | 43 |
| 37243 Vasc embolize/occlude organ | $666 | $991 | -33% | 62 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $137 | $200 | -31% | 61 |
| 43274 Ercp duct stent placement | $483 | $689 | -30% | 70 |
| 77080 Dxa bone density axial | $41 | $58 | -30% | 82 |
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 Illinois?
Aetna ranks 3rd of 4 in Illinois with an index of 88. It is highest on 1% of codes.
Are Aetna's Illinois rates above or below its national level?
About 5% above.
Which procedure does Aetna pay most above market in Illinois?
CPT 88342 (Imhchem/imcytchm 1st antb), at 144% of the Illinois 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 Illinois?
Compare your negotiated rates for these codes with Illinois medians for each payer.