Aetna negotiated rates in Utah
How Aetna's Utah rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Aetna in Utah at a glance
What the data shows
Aetna ranks 4th of 4 payers in Utah with a rate index of 90 (100 = the Utah market median), across 213 procedure codes.
Aetna has the highest median for only 16% of codes in Utah; UnitedHealthcare leads with an index of 111 in the files analyzed.
Aetna's Utah rates sit 9% above its own national level, the 12th highest of its 51 states.
Largest premium over the Utah market: CPT 43264 (Ercp remove duct calculi) at 188% of market; largest discount: CPT 77280 (Ther rad simulaj field smpl) at 51%.
How the four payers compare in Utah
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 111 | 1 | 48% | 649 | |
| Blue Cross Blue Shield | 99 | 2 | 22% | 667 | |
| Cigna | 94 | 3 | 14% | 751 | |
| Aetna | 90 | 4 | 16% | 418 |
Where Aetna pays most and least against the Utah market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 43264 Ercp remove duct calculi | $1,262 | $670 | +88% | 33 |
| 43238 Egd us fine needle bx/aspir | $721 | $395 | +82% | 25 |
| 43259 Egd us exam duodenum/jejunum | $745 | $409 | +82% | 27 |
| 43237 Endoscopic us exam esoph | $578 | $333 | +74% | 27 |
| 43255 Egd control bleeding any | $693 | $418 | +66% | 33 |
| 76775 Us exam abdo back wall lim | $172 | $106 | +62% | 24 |
| 43274 Ercp duct stent placement | $1,195 | $757 | +58% | 31 |
| 96413 Chemo iv infusion 1 hr | $320 | $203 | +58% | 29 |
Furthest below market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 77280 Ther rad simulaj field smpl | $203 | $398 | -49% | 21 |
| 73610 X-ray exam of ankle | $35 | $53 | -34% | 40 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $91 | $136 | -33% | 19 |
| 73562 X-ray exam of knee 3 | $40 | $59 | -32% | 46 |
| 73564 X-ray exam knee 4 or more | $46 | $67 | -31% | 43 |
| 73560 X-ray exam of knee 1 or 2 | $33 | $49 | -31% | 40 |
| 11301 Shave skin lesion 0.6-1.0 cm | $54 | $77 | -30% | 55 |
| 73030 X-ray exam of shoulder | $34 | $49 | -30% | 41 |
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 Utah?
Aetna ranks 4th of 4 in Utah with an index of 90. It is highest on 16% of codes.
Are Aetna's Utah rates above or below its national level?
About 9% above.
Which procedure does Aetna pay most above market in Utah?
CPT 43264 (Ercp remove duct calculi), at 188% of the Utah 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 Utah?
Compare your negotiated rates for these codes with Utah medians for each payer.