Aetna · West Virginia · commercial in-network

Aetna negotiated rates in West Virginia

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

Aetna in West Virginia at a glance

Across 193 procedure codes for 8 specialties
Rate index vs state market
76
24% below the West Virginia median
Rank in state
4 of 4
UHC 130 · Cigna 110 · BCBS 78 · Aetna 76
vs own national
86
Aetna's level vs its national median
Codes where highest
0%
of 193 codes
329 sampled providers264 TINs193 codesMedian 110% of Medicare · method

What the data shows

Generated from West Virginia and Aetna data only
1

Aetna ranks 4th of 4 payers in West Virginia with a rate index of 76 (100 = the West Virginia market median), across 193 procedure codes.

2

Aetna has the highest median for only 0% of codes in West Virginia; UnitedHealthcare leads with an index of 130 in the files analyzed.

3

Aetna's West Virginia rates sit 14% below its own national level, the 46th highest of its 51 states.

4

Largest premium over the West Virginia market: CPT 88312 (Special stains group 1) at 104% of market; largest discount: CPT 51720 (Treatment of bladder lesion) at 39%.

How the four payers compare in West Virginia

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1301
130
70%512
Cigna1102
110
30%518
Blue Cross Blue Shield783
78
1%292
Aetna764
76
0%329

Where Aetna pays most and least against the West Virginia market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88312
Special stains group 1
$86$83+4%34
92025
Cptrized corneal topography
$34$34-1%35
90960
Esrd srv 4 visits p mo 20+
$383$393-3%32
22558
Arthrd ant ntrbd min dsc lum
$2,189$2,266-3%24
97110
Therapeutic exercises
$30$32-4%39
92134
Cptrz oph dx img pst sgm rta
$39$40-5%42
92202
Opscpy extnd on/mac draw
$14$15-5%19
92201
Opscpy extnd rta draw uni/bi
$22$23-5%29

Furthest below market

CodeAetnaMarketGapProv.
51720
Treatment of bladder lesion
$48$122-61%23
51700
Irrigation of bladder
$34$85-60%21
11104
Punch bx skin single lesion
$44$107-58%16
93298
Rem interrog dev eval scrms
$29$69-58%47
52000
Cystourethroscopy
$88$210-58%26
11102
Tangntl bx skin single les
$37$85-57%16
51702
Insert temp bladder cath
$29$65-55%23
52224
Cystoscopy and treatment
$213$451-53%18

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 West Virginia?

Aetna ranks 4th of 4 in West Virginia with an index of 76. It is highest on 0% of codes.

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

About 14% below.

Which procedure does Aetna pay most above market in West Virginia?

CPT 88312 (Special stains group 1), at 104% of the West 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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