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
What the data shows
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.
Aetna has the highest median for only 1% of codes in North Carolina; UnitedHealthcare leads with an index of 111 in the files analyzed.
Aetna's North Carolina rates sit 10% below its own national level, the 39th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 111 | 1 | 46% | 747 | |
| Cigna | 103 | 2 | 31% | 851 | |
| Blue Cross Blue Shield | 100 | 3 | 22% | 976 | |
| Aetna | 64 | 4 | 1% | 568 |
Where Aetna pays most and least against the North Carolina market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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 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
- 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 North Carolina?
Compare your negotiated rates for these codes with North Carolina medians for each payer.