Aetna · Rhode Island · commercial in-network

Aetna negotiated rates in Rhode Island

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

Aetna in Rhode Island at a glance

Across 227 procedure codes for 8 specialties
Rate index vs state market
87
13% below the Rhode Island median
Rank in state
4 of 4
UHC 129 · Cigna 110 · BCBS 90 · Aetna 87
vs own national
103
Aetna's level vs its national median
Codes where highest
12%
of 227 codes
422 sampled providers321 TINs227 codesMedian 135% of Medicare · method

What the data shows

Generated from Rhode Island and Aetna data only
1

Aetna ranks 4th of 4 payers in Rhode Island with a rate index of 87 (100 = the Rhode Island market median), across 227 procedure codes.

2

Aetna has the highest median for only 12% of codes in Rhode Island; UnitedHealthcare leads with an index of 129 in the files analyzed.

3

Aetna's Rhode Island rates sit 3% above its own national level, the 18th highest of its 51 states.

4

Largest premium over the Rhode Island market: CPT 92250 (Fundus photography w/i&r) at 198% of market; largest discount: CPT 64566 (Neuroeltrd stim post tibial) at 54%.

How the four payers compare in Rhode Island

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1291
129
60%468
Cigna1102
110
26%562
Blue Cross Blue Shield903
90
1%581
Aetna874
87
12%422

Where Aetna pays most and least against the Rhode Island market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
92250
Fundus photography w/i&r
$93$47+98%47
77080
Dxa bone density axial
$98$56+76%54
92136
Ophthalmic biometry
$105$62+71%46
92083
Extended visual field xm
$107$69+54%47
72148
Mri lumbar spine w/o dye
$600$402+49%94
72141
Mri neck spine w/o dye
$600$404+48%55
92133
Cptrzd oph dx img pst sgm on
$56$38+46%47
70551
Mri brain stem w/o dye
$600$416+44%55

Furthest below market

CodeAetnaMarketGapProv.
64566
Neuroeltrd stim post tibial
$36$66-46%19
99490
Chrnc care mgmt staff 1st 20
$33$58-42%132
11301
Shave skin lesion 0.6-1.0 cm
$54$92-42%23
52224
Cystoscopy and treatment
$233$397-41%38
99457
Rpm tx mgmt 1st 20 min
$33$55-40%65
71045
X-ray exam chest 1 view
$20$33-39%54
93297
Rem interrog dev eval icpms
$32$52-38%44
26055
Incise finger tendon sheath
$394$639-38%85

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 Rhode Island?

Aetna ranks 4th of 4 in Rhode Island with an index of 87. It is highest on 12% of codes.

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

About 3% above.

Which procedure does Aetna pay most above market in Rhode Island?

CPT 92250 (Fundus photography w/i&r), at 198% of the Rhode Island 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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