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
What the data shows
Aetna ranks 4th of 4 payers in Pennsylvania with a rate index of 82 (100 = the Pennsylvania market median), across 228 procedure codes.
Aetna has the highest median for only 5% of codes in Pennsylvania; UnitedHealthcare leads with an index of 115 in the files analyzed.
Aetna's Pennsylvania rates sit 5% below its own national level, the 34th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 115 | 1 | 75% | 751 | |
| Blue Cross Blue Shield | 101 | 2 | 18% | 564 | |
| Cigna | 94 | 3 | 2% | 788 | |
| Aetna | 82 | 4 | 5% | 679 |
Where Aetna pays most and least against the Pennsylvania market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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 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
- 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 Pennsylvania?
Compare your negotiated rates for these codes with Pennsylvania medians for each payer.