Aetna · Maine · commercial in-network

Aetna negotiated rates in Maine

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

Aetna in Maine at a glance

Across 223 procedure codes for 8 specialties
Rate index vs state market
85
15% below the Maine median
Rank in state
4 of 4
UHC 124 · BCBS 103 · Cigna 100 · Aetna 85
vs own national
103
Aetna's level vs its national median
Codes where highest
4%
of 223 codes
552 sampled providers342 TINs223 codesMedian 133% of Medicare · method

What the data shows

Generated from Maine and Aetna data only
1

Aetna ranks 4th of 4 payers in Maine with a rate index of 85 (100 = the Maine market median), across 223 procedure codes.

2

Aetna has the highest median for only 4% of codes in Maine; UnitedHealthcare leads with an index of 124 in the files analyzed.

3

Aetna's Maine rates sit 3% above its own national level, the 19th highest of its 51 states.

4

Largest premium over the Maine market: CPT 37243 (Vasc embolize/occlude organ) at 129% of market; largest discount: CPT 99487 (Cplx chrnc care 1st 60 min) at 32%.

How the four payers compare in Maine

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1241
124
74%546
Blue Cross Blue Shield1032
103
18%215
Cigna1003
100
9%597
Aetna854
85
4%552

Where Aetna pays most and least against the Maine market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
37243
Vasc embolize/occlude organ
$1,119$869+29%95
72131
Ct lumbar spine w/o dye
$260$220+18%104
72125
Ct neck spine w/o dye
$262$228+14%107
71260
Ct thorax dx c+
$321$290+11%105
74174
Cta abd&plvs w/contrast
$615$560+10%103
70450
Ct head/brain w/o dye
$186$170+9%108
71250
Ct thorax dx c-
$245$225+9%107
51798
Us urine capacity measure
$25$23+9%38

Furthest below market

CodeAetnaMarketGapProv.
99487
Cplx chrnc care 1st 60 min
$46$145-68%23
93297
Rem interrog dev eval icpms
$30$92-67%26
96372
Ther/proph/diag inj sc/im
$15$28-46%102
14041
Tis trnfr f/c/c/m/n/a/g/h/f
$741$1,335-44%21
99490
Chrnc care mgmt staff 1st 20
$36$64-43%214
14061
Tis trnfr e/n/e/l10.1-30sqcm
$797$1,398-43%25
17000
Destruct premalg lesion
$52$91-43%29
15260
Fth/gft fr n/e/e/l 20 sqcm/<
$801$1,398-43%27

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 Maine?

Aetna ranks 4th of 4 in Maine with an index of 85. It is highest on 4% of codes.

Are Aetna&#39;s Maine rates above or below its national level?

About 3% above.

Which procedure does Aetna pay most above market in Maine?

CPT 37243 (Vasc embolize/occlude organ), at 129% of the Maine 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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