Aetna · Texas · commercial in-network

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

Across 228 procedure codes for 8 specialties
Rate index vs state market
95
5% below the Texas median
Rank in state
3 of 4
UHC 124 · Cigna 108 · Aetna 95 · BCBS 88
vs own national
93
Aetna's level vs its national median
Codes where highest
5%
of 228 codes
764 sampled providers664 TINs228 codesMedian 114% of Medicare · method

What the data shows

Generated from Texas and Aetna data only
1

Aetna ranks 3rd of 4 payers in Texas with a rate index of 95 (100 = the Texas market median), across 228 procedure codes.

2

Aetna has the highest median for only 5% of codes in Texas; UnitedHealthcare leads with an index of 124 in the files analyzed.

3

Aetna's Texas rates sit 7% below its own national level, the 36th highest of its 51 states.

4

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

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1241
124
81%824
Cigna1082
108
11%822
Aetna953
95
5%764
Blue Cross Blue Shield884
88
4%1,003

Where Aetna pays most and least against the Texas market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
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

CodeAetnaMarketGapProv.
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

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 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

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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