Aetna · Wisconsin · commercial in-network

Aetna negotiated rates in Wisconsin

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

Aetna in Wisconsin at a glance

Across 225 procedure codes for 8 specialties
Rate index vs state market
51
49% below the Wisconsin median
Rank in state
4 of 4
UHC 125 · BCBS 114 · Cigna 67 · Aetna 51
vs own national
98
Aetna's level vs its national median
Codes where highest
0%
of 225 codes
291 sampled providers290 TINs225 codesMedian 124% of Medicare · method

What the data shows

Generated from Wisconsin and Aetna data only
1

Aetna ranks 4th of 4 payers in Wisconsin with a rate index of 51 (100 = the Wisconsin market median), across 225 procedure codes.

2

Aetna has the highest median for only 0% of codes in Wisconsin; UnitedHealthcare leads with an index of 125 in the files analyzed.

3

Aetna's Wisconsin rates sit 2% below its own national level, the 27th highest of its 51 states.

4

Largest premium over the Wisconsin market: CPT 88313 (Special stains group 2) at 102% of market; largest discount: CPT 64566 (Neuroeltrd stim post tibial) at 23%.

How the four payers compare in Wisconsin

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1251
125
57%610
Blue Cross Blue Shield1142
114
42%733
Cigna673
67
1%296
Aetna514
51
0%291

Where Aetna pays most and least against the Wisconsin market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88313
Special stains group 2
$94$92+2%31
88312
Special stains group 1
$130$129+1%55
74183
Mri abd w/o cntr flwd cntr
$821$821+0%47
70553
Mri brain stem w/o & w/dye
$771$785-2%48
73221
Mri joint upr extrem w/o dye
$489$500-2%71
93229
Remote 30 day ecg tech supp
$1,603$1,653-3%22
73721
Mri jnt of lwr extre w/o dye
$488$504-3%71
72148
Mri lumbar spine w/o dye
$461$481-4%72

Furthest below market

CodeAetnaMarketGapProv.
64566
Neuroeltrd stim post tibial
$27$119-77%29
52224
Cystoscopy and treatment
$202$800-75%28
51720
Treatment of bladder lesion
$44$167-74%26
51702
Insert temp bladder cath
$25$96-74%34
51700
Irrigation of bladder
$30$114-74%30
52332
Cystoscopy and treatment
$156$576-73%34
17004
Destroy premal lesions 15/>
$96$343-72%22
52281
Cystoscopy and treatment
$152$540-72%28

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 Wisconsin?

Aetna ranks 4th of 4 in Wisconsin with an index of 51. It is highest on 0% of codes.

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

About 2% below.

Which procedure does Aetna pay most above market in Wisconsin?

CPT 88313 (Special stains group 2), at 102% of the Wisconsin 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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