Aetna · Ohio · commercial in-network

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 overviewOhio marketSnapshot Aug 2026

Aetna in Ohio at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
88
12% below the Ohio median
Rank in state
4 of 4
UHC 115 · BCBS 95 · Cigna 95 · Aetna 88
vs own national
101
Aetna's level vs its national median
Codes where highest
6%
of 228 codes
711 sampled providers521 TINs228 codesMedian 137% of Medicare · method

What the data shows

Generated from Ohio and Aetna data only
1

Aetna ranks 4th of 4 payers in Ohio with a rate index of 88 (100 = the Ohio market median), across 228 procedure codes.

2

Aetna has the highest median for only 6% of codes in Ohio; UnitedHealthcare leads with an index of 115 in the files analyzed.

3

Aetna's Ohio rates sit 1% above its own national level, the 22nd highest of its 51 states.

4

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

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1151
115
76%802
Blue Cross Blue Shield952
95
13%893
Cigna953
95
5%806
Aetna884
88
6%711

Where Aetna pays most and least against the Ohio market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
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

CodeAetnaMarketGapProv.
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

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 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

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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