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
What the data shows
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.
Aetna has the highest median for only 5% of codes in New York; UnitedHealthcare leads with an index of 128 in the files analyzed.
Aetna's New York rates sit 10% below its own national level, the 40th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 128 | 1 | 41% | 801 | |
| Cigna | 120 | 2 | 46% | 672 | |
| Blue Cross Blue Shield | 97 | 3 | 8% | 898 | |
| Aetna | 83 | 4 | 5% | 755 |
Where Aetna pays most and least against the New York market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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 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
- 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 York?
Compare your negotiated rates for these codes with New York medians for each payer.