Aetna · Illinois · commercial in-network

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

Across 228 procedure codes for 8 specialties
Rate index vs state market
88
12% below the Illinois median
Rank in state
3 of 4
UHC 133 · Cigna 106 · Aetna 88 · BCBS 86
vs own national
105
Aetna's level vs its national median
Codes where highest
1%
of 228 codes
626 sampled providers554 TINs228 codesMedian 128% of Medicare · method

What the data shows

Generated from Illinois and Aetna data only
1

Aetna ranks 3rd of 4 payers in Illinois with a rate index of 88 (100 = the Illinois market median), across 228 procedure codes.

2

Aetna has the highest median for only 1% of codes in Illinois; UnitedHealthcare leads with an index of 133 in the files analyzed.

3

Aetna's Illinois rates sit 5% above its own national level, the 16th highest of its 51 states.

4

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

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1331
133
86%706
Cigna1062
106
8%644
Aetna883
88
1%626
Blue Cross Blue Shield864
86
5%841

Where Aetna pays most and least against the Illinois market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
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

CodeAetnaMarketGapProv.
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

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 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

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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