Aetna · Virginia · commercial in-network

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

Across 228 procedure codes for 8 specialties
Rate index vs state market
93
7% below the Virginia median
Rank in state
3 of 4
UHC 116 · Cigna 102 · Aetna 93 · BCBS 87
vs own national
102
Aetna's level vs its national median
Codes where highest
12%
of 228 codes
752 sampled providers572 TINs228 codesMedian 124% of Medicare · method

What the data shows

Generated from Virginia and Aetna data only
1

Aetna ranks 3rd of 4 payers in Virginia with a rate index of 93 (100 = the Virginia market median), across 228 procedure codes.

2

Aetna has the highest median for only 12% of codes in Virginia; UnitedHealthcare leads with an index of 116 in the files analyzed.

3

Aetna's Virginia rates sit 2% above its own national level, the 20th highest of its 51 states.

4

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

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1161
116
64%733
Cigna1022
102
20%787
Aetna933
93
12%752
Blue Cross Blue Shield874
87
4%813

Where Aetna pays most and least against the Virginia market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
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

CodeAetnaMarketGapProv.
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

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 Virginia?

Aetna ranks 3rd of 4 in Virginia with an index of 93. It is highest on 12% of codes.

Are Aetna&#39;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

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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