Aetna · Pennsylvania · commercial in-network

Aetna negotiated rates in Pennsylvania

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

Aetna in Pennsylvania at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
82
18% below the Pennsylvania median
Rank in state
4 of 4
UHC 115 · BCBS 101 · Cigna 94 · Aetna 82
vs own national
95
Aetna's level vs its national median
Codes where highest
5%
of 228 codes
679 sampled providers611 TINs228 codesMedian 116% of Medicare · method

What the data shows

Generated from Pennsylvania and Aetna data only
1

Aetna ranks 4th of 4 payers in Pennsylvania with a rate index of 82 (100 = the Pennsylvania market median), across 228 procedure codes.

2

Aetna has the highest median for only 5% of codes in Pennsylvania; UnitedHealthcare leads with an index of 115 in the files analyzed.

3

Aetna's Pennsylvania rates sit 5% below its own national level, the 34th highest of its 51 states.

4

Largest premium over the Pennsylvania market: CPT 93229 (Remote 30 day ecg tech supp) at 151% of market; largest discount: CPT 11102 (Tangntl bx skin single les) at 43%.

How the four payers compare in Pennsylvania

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1151
115
75%751
Blue Cross Blue Shield1012
101
18%564
Cigna943
94
2%788
Aetna824
82
5%679

Where Aetna pays most and least against the Pennsylvania market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
93229
Remote 30 day ecg tech supp
$1,602$1,062+51%43
55866
Laps surg prst8ect rpbic rad
$2,459$2,060+19%58
36482
Endoven ther chem adhes 1st
$324$273+19%47
73221
Mri joint upr extrem w/o dye
$425$365+16%139
72148
Mri lumbar spine w/o dye
$425$367+16%141
93294
Rem interrog evl pm/ldls pm
$51$44+15%71
72141
Mri neck spine w/o dye
$425$369+15%89
73721
Mri jnt of lwr extre w/o dye
$425$370+15%143

Furthest below market

CodeAetnaMarketGapProv.
11102
Tangntl bx skin single les
$38$90-57%95
11104
Punch bx skin single lesion
$48$112-57%94
43248
Egd guide wire insertion
$193$372-48%83
11301
Shave skin lesion 0.6-1.0 cm
$53$101-48%93
11302
Shave skin lesion 1.1-2.0 cm
$62$115-46%92
99426
Prin care mgmt staff 1st 30
$44$80-45%21
17313
Mohs 1 stage t/a/l
$327$590-45%84
45384
Colonoscopy w/lesion removal
$265$467-43%86

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 Pennsylvania?

Aetna ranks 4th of 4 in Pennsylvania with an index of 82. It is highest on 5% of codes.

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

About 5% below.

Which procedure does Aetna pay most above market in Pennsylvania?

CPT 93229 (Remote 30 day ecg tech supp), at 151% of the Pennsylvania 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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