Aetna negotiated rates in Virginia
How Aetna's Virginia rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Aetna in Virginia at a glance
What the data shows
Aetna ranks 3rd of 4 payers in Virginia with a rate index of 93 (100 = the Virginia market median), across 228 procedure codes.
Aetna has the highest median for only 12% of codes in Virginia; UnitedHealthcare leads with an index of 116 in the files analyzed.
Aetna's Virginia rates sit 2% above its own national level, the 20th highest of its 51 states.
Largest premium over the Virginia market: CPT 88312 (Special stains group 1) at 150% of market; largest discount: CPT 93297 (Rem interrog dev eval icpms) at 64%.
How the four payers compare in Virginia
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 116 | 1 | 64% | 733 | |
| Cigna | 102 | 2 | 20% | 787 | |
| Aetna | 93 | 3 | 12% | 752 | |
| Blue Cross Blue Shield | 87 | 4 | 4% | 813 |
Where Aetna pays most and least against the Virginia market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 88312 Special stains group 1 | $101 | $67 | +50% | 165 |
| 72148 Mri lumbar spine w/o dye | $600 | $405 | +48% | 162 |
| 43248 Egd guide wire insertion | $460 | $321 | +43% | 94 |
| 73221 Mri joint upr extrem w/o dye | $599 | $422 | +42% | 163 |
| 73721 Mri jnt of lwr extre w/o dye | $589 | $422 | +40% | 164 |
| 43251 Egd remove lesion snare | $522 | $378 | +38% | 96 |
| 88313 Special stains group 2 | $79 | $57 | +37% | 67 |
| 43249 Esoph egd dilation <30 mm | $337 | $247 | +37% | 89 |
Furthest below market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 93297 Rem interrog dev eval icpms | $30 | $46 | -36% | 92 |
| 93298 Rem interrog dev eval scrms | $30 | $45 | -35% | 89 |
| 99426 Prin care mgmt staff 1st 30 | $49 | $74 | -34% | 43 |
| 52287 Cystoscopy chemodenervation | $238 | $353 | -33% | 74 |
| 99457 Rpm tx mgmt 1st 20 min | $32 | $47 | -32% | 112 |
| 52281 Cystoscopy and treatment | $223 | $317 | -30% | 73 |
| 74177 Ct abd & pelvis w/contrast | $320 | $443 | -28% | 78 |
| 99350 Home/res vst est high mdm 60 | $150 | $208 | -28% | 50 |
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 Virginia?
Aetna ranks 3rd of 4 in Virginia with an index of 93. It is highest on 12% of codes.
Are Aetna's Virginia rates above or below its national level?
About 2% above.
Which procedure does Aetna pay most above market in Virginia?
CPT 88312 (Special stains group 1), at 150% of the Virginia 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 Virginia?
Compare your negotiated rates for these codes with Virginia medians for each payer.