Aetna negotiated rates in Texas
How Aetna's Texas rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Aetna in Texas at a glance
What the data shows
Aetna ranks 3rd of 4 payers in Texas with a rate index of 95 (100 = the Texas market median), across 228 procedure codes.
Aetna has the highest median for only 5% of codes in Texas; UnitedHealthcare leads with an index of 124 in the files analyzed.
Aetna's Texas rates sit 7% below its own national level, the 36th highest of its 51 states.
Largest premium over the Texas market: CPT 88312 (Special stains group 1) at 148% of market; largest discount: CPT 93297 (Rem interrog dev eval icpms) at 51%.
How the four payers compare in Texas
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 124 | 1 | 81% | 824 | |
| Cigna | 108 | 2 | 11% | 822 | |
| Aetna | 95 | 3 | 5% | 764 | |
| Blue Cross Blue Shield | 88 | 4 | 4% | 1,003 |
Where Aetna pays most and least against the Texas market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 88312 Special stains group 1 | $90 | $61 | +48% | 153 |
| 88313 Special stains group 2 | $65 | $45 | +46% | 61 |
| 70551 Mri brain stem w/o dye | $393 | $272 | +44% | 78 |
| 72141 Mri neck spine w/o dye | $381 | $265 | +44% | 78 |
| 72148 Mri lumbar spine w/o dye | $316 | $225 | +41% | 147 |
| 88342 Imhchem/imcytchm 1st antb | $87 | $63 | +38% | 92 |
| 73721 Mri jnt of lwr extre w/o dye | $319 | $238 | +34% | 151 |
| 73221 Mri joint upr extrem w/o dye | $318 | $238 | +34% | 151 |
Furthest below market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 93297 Rem interrog dev eval icpms | $27 | $52 | -49% | 70 |
| 93298 Rem interrog dev eval scrms | $30 | $51 | -41% | 80 |
| 43239 Egd biopsy single/multiple | $180 | $266 | -32% | 98 |
| 51700 Irrigation of bladder | $43 | $61 | -30% | 89 |
| 43235 Egd diagnostic brush wash | $162 | $230 | -30% | 95 |
| 45380 Colonoscopy and biopsy | $265 | $376 | -30% | 98 |
| 26055 Incise finger tendon sheath | $345 | $476 | -28% | 82 |
| 64566 Neuroeltrd stim post tibial | $41 | $56 | -26% | 58 |
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 Texas?
Aetna ranks 3rd of 4 in Texas with an index of 95. It is highest on 5% of codes.
Are Aetna's Texas rates above or below its national level?
About 7% below.
Which procedure does Aetna pay most above market in Texas?
CPT 88312 (Special stains group 1), at 148% of the Texas 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 Texas?
Compare your negotiated rates for these codes with Texas medians for each payer.