Aetna negotiated rates in New Jersey
How Aetna's New Jersey rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Aetna in New Jersey at a glance
What the data shows
Aetna ranks 4th of 4 payers in New Jersey with a rate index of 82 (100 = the New Jersey market median), across 228 procedure codes.
Aetna has the highest median for only 7% of codes in New Jersey; UnitedHealthcare leads with an index of 109 in the files analyzed.
Aetna's New Jersey rates sit 0% below its own national level, the 25th highest of its 51 states.
Largest premium over the New Jersey market: CPT 92250 (Fundus photography w/i&r) at 169% of market; largest discount: CPT 76872 (Us transrectal) at 54%.
How the four payers compare in New Jersey
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 109 | 1 | 43% | 724 | |
| Cigna | 104 | 2 | 24% | 795 | |
| Blue Cross Blue Shield | 101 | 3 | 27% | 787 | |
| Aetna | 82 | 4 | 7% | 807 |
Where Aetna pays most and least against the New Jersey market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 92250 Fundus photography w/i&r | $75 | $44 | +69% | 110 |
| 67028 Injection eye drug | $158 | $106 | +48% | 107 |
| 65778 Cover eye w/membrane | $82 | $59 | +38% | 106 |
| 66982 Xcapsl ctrc rmvl cplx wo ecp | $981 | $797 | +23% | 107 |
| 76512 Oph us dx b-scan | $75 | $62 | +22% | 109 |
| 72110 X-ray exam l-2 spine 4/>vws | $91 | $75 | +20% | 78 |
| 67210 Treatment of retinal lesion | $618 | $519 | +19% | 101 |
| 67108 Repair detached retina | $1,482 | $1,276 | +16% | 97 |
Furthest below market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 76872 Us transrectal | $115 | $210 | -46% | 99 |
| 99490 Chrnc care mgmt staff 1st 20 | $35 | $59 | -41% | 284 |
| 99457 Rpm tx mgmt 1st 20 min | $36 | $57 | -37% | 172 |
| 93298 Rem interrog dev eval scrms | $34 | $54 | -37% | 98 |
| 99426 Prin care mgmt staff 1st 30 | $56 | $89 | -37% | 71 |
| 99202 Office o/p new sf 15 min | $41 | $63 | -35% | 84 |
| 99350 Home/res vst est high mdm 60 | $147 | $228 | -35% | 82 |
| 76857 Us exam pelvic limited | $55 | $85 | -35% | 92 |
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 New Jersey?
Aetna ranks 4th of 4 in New Jersey with an index of 82. It is highest on 7% of codes.
Are Aetna's New Jersey rates above or below its national level?
About 0% below.
Which procedure does Aetna pay most above market in New Jersey?
CPT 92250 (Fundus photography w/i&r), at 169% of the New Jersey 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 New Jersey?
Compare your negotiated rates for these codes with New Jersey medians for each payer.