Aetna · Washington · commercial in-network

Aetna negotiated rates in Washington

How Aetna's Washington rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.

Aetna in Washington at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
91
9% below the Washington median
Rank in state
4 of 4
UHC 106 · Cigna 99 · BCBS 98 · Aetna 91
vs own national
142
Aetna's level vs its national median
Codes where highest
19%
of 228 codes
708 sampled providers426 TINs228 codesMedian 191% of Medicare · method

What the data shows

Generated from Washington and Aetna data only
1

Aetna ranks 4th of 4 payers in Washington with a rate index of 91 (100 = the Washington market median), across 228 procedure codes.

2

Aetna has the highest median for only 19% of codes in Washington; UnitedHealthcare leads with an index of 106 in the files analyzed.

3

Aetna's Washington rates sit 42% above its own national level, the 3rd highest of its 51 states.

4

Largest premium over the Washington market: CPT 72158 (Mri lumbar spine w/o & w/dye) at 125% of market; largest discount: CPT 11102 (Tangntl bx skin single les) at 48%.

How the four payers compare in Washington

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1061
106
60%695
Cigna992
99
13%749
Blue Cross Blue Shield983
98
8%799
Aetna914
91
19%708

Where Aetna pays most and least against the Washington market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
72158
Mri lumbar spine w/o & w/dye
$920$734+25%99
72141
Mri neck spine w/o dye
$562$451+25%99
72197
Mri pelvis w/o & w/dye
$979$803+22%99
93296
Rem interrog evl pm/ids
$61$50+21%86
72131
Ct lumbar spine w/o dye
$367$305+20%99
72125
Ct neck spine w/o dye
$369$307+20%99
55866
Laps surg prst8ect rpbic rad
$3,027$2,522+20%70
70450
Ct head/brain w/o dye
$290$245+19%99

Furthest below market

CodeAetnaMarketGapProv.
11102
Tangntl bx skin single les
$54$112-52%84
99487
Cplx chrnc care 1st 60 min
$93$191-52%60
11104
Punch bx skin single lesion
$68$139-51%84
93297
Rem interrog dev eval icpms
$42$83-49%37
11301
Shave skin lesion 0.6-1.0 cm
$73$141-48%83
11302
Shave skin lesion 1.1-2.0 cm
$86$163-47%81
99348
Home/res vst est low mdm 30
$92$163-44%28
99426
Prin care mgmt staff 1st 30
$59$104-43%24

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 Washington?

Aetna ranks 4th of 4 in Washington with an index of 91. It is highest on 19% of codes.

Are Aetna's Washington rates above or below its national level?

About 42% above.

Which procedure does Aetna pay most above market in Washington?

CPT 72158 (Mri lumbar spine w/o & w/dye), at 125% of the Washington 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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