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
What the data shows
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.
Aetna has the highest median for only 0% of codes in West Virginia; UnitedHealthcare leads with an index of 130 in the files analyzed.
Aetna's West Virginia rates sit 14% below its own national level, the 46th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 130 | 1 | 70% | 512 | |
| Cigna | 110 | 2 | 30% | 518 | |
| Blue Cross Blue Shield | 78 | 3 | 1% | 292 | |
| Aetna | 76 | 4 | 0% | 329 |
Where Aetna pays most and least against the West Virginia market
Highest above market
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | Aetna | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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 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
- 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 West Virginia?
Compare your negotiated rates for these codes with West Virginia medians for each payer.