Aetna negotiated rates in Ohio
How Aetna's Ohio rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Aetna in Ohio at a glance
What the data shows
Aetna ranks 4th of 4 payers in Ohio with a rate index of 88 (100 = the Ohio market median), across 228 procedure codes.
Aetna has the highest median for only 6% of codes in Ohio; UnitedHealthcare leads with an index of 115 in the files analyzed.
Aetna's Ohio rates sit 1% above its own national level, the 22nd highest of its 51 states.
Largest premium over the Ohio market: CPT 93298 (Rem interrog dev eval scrms) at 155% of market; largest discount: CPT 51700 (Irrigation of bladder) at 48%.
How the four payers compare in Ohio
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 115 | 1 | 76% | 802 | |
| Blue Cross Blue Shield | 95 | 2 | 13% | 893 | |
| Cigna | 95 | 3 | 5% | 806 | |
| Aetna | 88 | 4 | 6% | 711 |
Where Aetna pays most and least against the Ohio market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $104 | $67 | +55% | 83 |
| 93297 Rem interrog dev eval icpms | $88 | $60 | +46% | 58 |
| 37243 Vasc embolize/occlude organ | $1,093 | $934 | +17% | 70 |
| 43276 Ercp stent exchange w/dilate | $861 | $736 | +17% | 73 |
| 88342 Imhchem/imcytchm 1st antb | $91 | $79 | +15% | 72 |
| 88312 Special stains group 1 | $96 | $83 | +15% | 144 |
| 93280 Pm device progr eval dual | $132 | $118 | +12% | 81 |
| 96413 Chemo iv infusion 1 hr | $244 | $219 | +12% | 73 |
Furthest below market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 51700 Irrigation of bladder | $44 | $92 | -52% | 76 |
| 52000 Cystourethroscopy | $120 | $230 | -48% | 89 |
| 11104 Punch bx skin single lesion | $50 | $94 | -47% | 87 |
| 51720 Treatment of bladder lesion | $72 | $134 | -46% | 67 |
| 11102 Tangntl bx skin single les | $40 | $72 | -45% | 88 |
| 99426 Prin care mgmt staff 1st 30 | $47 | $83 | -44% | 30 |
| 51702 Insert temp bladder cath | $37 | $65 | -43% | 84 |
| 99487 Cplx chrnc care 1st 60 min | $70 | $121 | -42% | 24 |
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 Ohio?
Aetna ranks 4th of 4 in Ohio with an index of 88. It is highest on 6% of codes.
Are Aetna's Ohio rates above or below its national level?
About 1% above.
Which procedure does Aetna pay most above market in Ohio?
CPT 93298 (Rem interrog dev eval scrms), at 155% of the Ohio 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 Ohio?
Compare your negotiated rates for these codes with Ohio medians for each payer.