Aetna · North Carolina · commercial in-network

Aetna negotiated rates in North Carolina

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

Aetna in North Carolina at a glance

Across 227 procedure codes for 8 specialties
Rate index vs state market
64
36% below the North Carolina median
Rank in state
4 of 4
UHC 111 · Cigna 103 · BCBS 100 · Aetna 64
vs own national
90
Aetna's level vs its national median
Codes where highest
1%
of 227 codes
568 sampled providers466 TINs227 codesMedian 110% of Medicare · method

What the data shows

Generated from North Carolina and Aetna data only
1

Aetna ranks 4th of 4 payers in North Carolina with a rate index of 64 (100 = the North Carolina market median), across 227 procedure codes.

2

Aetna has the highest median for only 1% of codes in North Carolina; UnitedHealthcare leads with an index of 111 in the files analyzed.

3

Aetna's North Carolina rates sit 10% below its own national level, the 39th highest of its 51 states.

4

Largest premium over the North Carolina market: CPT 88312 (Special stains group 1) at 128% of market; largest discount: CPT 64566 (Neuroeltrd stim post tibial) at 32%.

How the four payers compare in North Carolina

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1111
111
46%747
Cigna1032
103
31%851
Blue Cross Blue Shield1003
100
22%976
Aetna644
64
1%568

Where Aetna pays most and least against the North Carolina market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88312
Special stains group 1
$86$68+28%105
92004
Compre oph exam new pt 1/>
$102$93+9%70
88313
Special stains group 2
$62$57+7%53
96910
Photchmtx tar&uvb/ptrltm&uvb
$112$107+5%36
88342
Imhchem/imcytchm 1st antb
$77$75+4%65
88305
Tissue exam by pathologist
$55$55+0%132
97110
Therapeutic exercises
$27$27+0%71
77280
Ther rad simulaj field smpl
$257$258-0%35

Furthest below market

CodeAetnaMarketGapProv.
64566
Neuroeltrd stim post tibial
$30$95-68%46
51702
Insert temp bladder cath
$34$102-67%57
51700
Irrigation of bladder
$41$122-66%56
52287
Cystoscopy chemodenervation
$182$535-66%53
51720
Treatment of bladder lesion
$58$166-65%55
52224
Cystoscopy and treatment
$198$559-65%49
52000
Cystourethroscopy
$112$305-63%59
52281
Cystoscopy and treatment
$178$482-63%55

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 North Carolina?

Aetna ranks 4th of 4 in North Carolina with an index of 64. It is highest on 1% of codes.

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

About 10% below.

Which procedure does Aetna pay most above market in North Carolina?

CPT 88312 (Special stains group 1), at 128% of the North Carolina 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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