Aetna · Massachusetts · commercial in-network

Aetna negotiated rates in Massachusetts

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

Aetna in Massachusetts at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
62
38% below the Massachusetts median
Rank in state
4 of 4
UHC 137 · Cigna 109 · BCBS 98 · Aetna 62
vs own national
95
Aetna's level vs its national median
Codes where highest
0%
of 228 codes
595 sampled providers535 TINs228 codesMedian 109% of Medicare · method

What the data shows

Generated from Massachusetts and Aetna data only
1

Aetna ranks 4th of 4 payers in Massachusetts with a rate index of 62 (100 = the Massachusetts market median), across 228 procedure codes.

2

Aetna has the highest median for only 0% of codes in Massachusetts; UnitedHealthcare leads with an index of 137 in the files analyzed.

3

Aetna's Massachusetts rates sit 5% below its own national level, the 33rd highest of its 51 states.

4

Largest premium over the Massachusetts market: CPT 51798 (Us urine capacity measure) at 112% of market; largest discount: CPT 93298 (Rem interrog dev eval scrms) at 23%.

How the four payers compare in Massachusetts

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1371
137
80%772
Cigna1092
109
14%808
Blue Cross Blue Shield983
98
5%837
Aetna624
62
0%595

Where Aetna pays most and least against the Massachusetts market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
51798
Us urine capacity measure
$29$26+12%46
92250
Fundus photography w/i&r
$81$76+6%83
72197
Mri pelvis w/o & w/dye
$719$719+0%68
74183
Mri abd w/o cntr flwd cntr
$720$720+0%69
92136
Ophthalmic biometry
$92$92+0%83
76512
Oph us dx b-scan
$73$74-2%80
70551
Mri brain stem w/o dye
$403$418-4%69
72141
Mri neck spine w/o dye
$391$408-4%68

Furthest below market

CodeAetnaMarketGapProv.
93298
Rem interrog dev eval scrms
$28$125-77%63
93297
Rem interrog dev eval icpms
$27$101-74%50
99487
Cplx chrnc care 1st 60 min
$62$178-65%33
76872
Us transrectal
$94$258-64%65
36482
Endoven ther chem adhes 1st
$124$338-63%31
36465
Njx noncmpnd sclrsnt 1 vein
$83$226-63%36
33285
Insj subq car rhythm mntr
$63$166-62%44
90960
Esrd srv 4 visits p mo 20+
$270$699-61%43

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 Massachusetts?

Aetna ranks 4th of 4 in Massachusetts with an index of 62. It is highest on 0% of codes.

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

About 5% below.

Which procedure does Aetna pay most above market in Massachusetts?

CPT 51798 (Us urine capacity measure), at 112% of the Massachusetts 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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