Aetna · New York · commercial in-network

Aetna negotiated rates in New York

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

Aetna in New York at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
83
17% below the New York median
Rank in state
4 of 4
UHC 128 · Cigna 120 · BCBS 97 · Aetna 83
vs own national
90
Aetna's level vs its national median
Codes where highest
5%
of 228 codes
755 sampled providers744 TINs228 codesMedian 112% of Medicare · method

What the data shows

Generated from New York and Aetna data only
1

Aetna ranks 4th of 4 payers in New York with a rate index of 83 (100 = the New York market median), across 228 procedure codes.

2

Aetna has the highest median for only 5% of codes in New York; UnitedHealthcare leads with an index of 128 in the files analyzed.

3

Aetna's New York rates sit 10% below its own national level, the 40th highest of its 51 states.

4

Largest premium over the New York market: CPT 92250 (Fundus photography w/i&r) at 142% of market; largest discount: CPT 64566 (Neuroeltrd stim post tibial) at 38%.

How the four payers compare in New York

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1281
128
41%801
Cigna1202
120
46%672
Blue Cross Blue Shield973
97
8%898
Aetna834
83
5%755

Where Aetna pays most and least against the New York market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
92250
Fundus photography w/i&r
$63$44+42%92
67108
Repair detached retina
$1,545$1,318+17%79
66984
Xcapsl ctrc rmvl w/o ecp
$758$669+13%93
65756
Corneal trnspl endothelial
$1,404$1,275+10%78
66991
Xcapsl ctrc rmvl insj 1+
$820$751+9%78
67036
Removal of inner eye fluid
$1,070$986+8%79
67042
Vit for macular hole
$1,366$1,264+8%79
92136
Ophthalmic biometry
$71$66+8%92

Furthest below market

CodeAetnaMarketGapProv.
64566
Neuroeltrd stim post tibial
$42$110-62%65
52224
Cystoscopy and treatment
$269$698-61%67
93297
Rem interrog dev eval icpms
$23$52-57%91
43255
Egd control bleeding any
$260$594-56%92
93298
Rem interrog dev eval scrms
$26$58-56%93
26055
Incise finger tendon sheath
$317$663-52%74
52648
Laser surgery of prostate
$911$1,884-52%59
96910
Photchmtx tar&uvb/ptrltm&uvb
$64$122-48%79

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 New York?

Aetna ranks 4th of 4 in New York with an index of 83. It is highest on 5% of codes.

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

About 10% below.

Which procedure does Aetna pay most above market in New York?

CPT 92250 (Fundus photography w/i&r), at 142% of the New York 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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