What does aetna pay gastroenterology groups in IL?

Median published rate is 85.2% of Medicare across 425 NPIs (September 2026 files).

Data as of the September 2026 payer files.

Across 200 procedure codes and 1 payer, the median published rate is 55 percent of locality-adjusted Medicare in the September 2026 payer files. Aetna is the only payer with enough confirmed NPIs to publish here, at 55 percent of Medicare, so there is no spread to compare yet. The best-covered row rests on 425 confirmed NPIs, and any combination under five is withheld rather than shown thin. These are contracted amounts the payer published, not what a practice was paid, and every row clears the ghost-rate filter, so each NPI counted here actually billed the code in the Medicare utilization file.

Published rates

What does aetna pay gastroenterology groups in IL?
Payer	Code	Site	n	p25	p50	p75	% of Medicare
Aetna	43239	professional	425	49.97	184.43	333.45	85.2%
Aetna	45385	professional	404	67.47	254.95	489.18	105.2%
Aetna	45380	professional	400	61.88	234.84	423.46	98.5%
Aetna	99214	professional	349	39.47	87.47	140.57	73.6%
Aetna	99204	professional	303	52.5	117.65	195.16	73.9%
Aetna	99213	professional	233	20.89	61.34	88.16	71.5%
Aetna	45378	professional	203	92.21	170.67	296.2	90.5%
Aetna	43235	professional	191	40.26	118.39	272.66	88.8%
Aetna	G0105	professional	168	91.25	158.3	297.2	80.1%
Aetna	99203	professional	149	34.16	77.13	114.07	75.4%
Aetna	G0121	professional	133	82.76	159.21	296.15	80.1%
Aetna	99215	professional	104	41	141.27	244.33	93.6%
Aetna	43249	professional	95	102.48	306.89	646.44	59.8%
Aetna	43264	professional	68	65.96	215.07	491.94	152.8%
Aetna	43274	professional	55	88.42	308.29	578.74	134.2%
Aetna	43248	professional	52	53.1	144.73	326.82	87.8%
Aetna	45381	professional	51	58.61	171.62	375.07	83.3%
Aetna	99205	professional	43	31.8	165.78	307.11	90.5%
Aetna	45390	professional	42	56.65	166.46	348.23	112%
Aetna	43255	professional	41	61.82	206.07	412.13	75.6%
Aetna	43251	professional	39	55.17	172.96	345.91	81%
Aetna	43237	professional	38	36.62	97.87	246.76	145%
Aetna	43262	professional	35	56.07	178.42	446.3	131.7%
Aetna	43259	professional	34	42.6	117.5	313.73	151.7%
Aetna	43238	professional	33	41.25	118.47	291.11	131.3%
Aetna	43242	professional	33	48.55	137.29	393.69	156%
Aetna	43246	professional	31	30.69	102.29	204.58	120.9%
Aetna	43275	professional	26	61.39	191.86	451.53	121.1%
Aetna	43247	professional	20	42.2	138.51	269.15	87.3%
Aetna	45384	professional	20	54.29	179.43	344.98	76.2%
Aetna	46221	professional	20	46.77	161.15	237.04	123.5%
Aetna	99212	professional	20	5.98	33.25	49.53	70.4%
Aetna	45330	professional	19	20.71	59.8	112.54	99.3%
Aetna	45382	professional	19	69.31	231.02	417.44	100.5%
Aetna	43270	professional	18	71.34	237.79	475.57	61.6%
Aetna	43236	professional	17	40.25	134.18	268.35	82.9%
Aetna	43276	professional	17	72.2	240.67	481.33	22%
Aetna	91110	professional	17	248.79	863.57	1343.87	173.8%
Aetna	43244	professional	16	36.72	120.93	237.01	85.3%
Aetna	43245	professional	16	57.91	191.85	360.43	71.9%
Aetna	45388	professional	16	202.89	673.83	1014.42	176.5%
Aetna	43250	professional	15	46.91	155.2	258.44	60.1%
Aetna	43266	professional	15	32.91	108.69	208.87	15.7%
Aetna	50590	professional	15	104.46	342.47	505.12	49.8%
Aetna	52000	professional	15	24.01	80.05	159.62	135.1%
Aetna	52005	professional	15	32.58	108.55	181.02	35.7%
Aetna	52260	professional	15	31.84	106.14	204.55	72.3%
Aetna	52310	professional	15	35.35	117.75	235.5	37.3%
Aetna	52320	professional	15	36.9	123.01	237.85	37.1%
Aetna	52332	professional	15	41.72	138.89	230.1	27.6%
Aetna	52352	professional	15	53.13	176.93	336.23	37.3%
Aetna	52354	professional	15	62.52	208.4	402.49	30.3%
Aetna	96365	professional	15	87.26	87.26	93.74	126.1%
Aetna	22633	professional	14	290.97	969.92	1369.92	8.5%
Aetna	43200	professional	14	26.55	87.84	158.43	69.7%
Aetna	43202	professional	14	34.52	114.44	205.65	46.6%
Aetna	43220	professional	14	76.05	253.4	445.47	87.9%
Aetna	43241	professional	14	21.33	70.58	125.99	74.8%
Aetna	43260	professional	14	48.27	159.92	285.68	36%
Aetna	43261	professional	14	50.8	168.19	299.95	36.2%
Aetna	43265	professional	14	64.85	214.79	383.34	26.3%
Aetna	43762	professional	14	19.82	62.83	99.1	162.7%
Aetna	45331	professional	14	26.73	88.34	136.51	71%
Aetna	45333	professional	14	31.8	104.63	181.32	63.9%
Aetna	45334	professional	14	45.63	150.45	235.16	78.6%
Aetna	45335	professional	14	26.79	88.44	136.43	71.8%
Aetna	45338	professional	14	31.49	103.76	182.08	58.4%
Aetna	45398	professional	14	80.12	246.26	400.61	103.5%
Aetna	46946	professional	14	63.78	194.7	292.05	51%
Aetna	52317	professional	14	92.2	307.31	539.65	42.8%
Aetna	52318	professional	14	71.09	236.24	399.35	43.6%
Aetna	52351	professional	14	45.31	148.18	227.95	37.1%
Aetna	52353	professional	14	58.85	192.12	295.98	26.3%
Aetna	52648	professional	14	175.96	576.28	864.41	42.2%
Aetna	53850	professional	14	142.03	443.63	662.71	82.6%
Aetna	53852	professional	14	141.6	442.44	657.73	74.9%
Aetna	64561	professional	14	85.11	261.56	387.44	13.9%
Aetna	10005	professional	13	14.47	47.87	73.06	30.9%
Aetna	10021	professional	13	10.98	36.3	56.85	141.9%
Aetna	11640	professional	13	25.45	80.23	113.75	128.7%
Aetna	11641	professional	13	30.24	92.41	135.2	138.6%
Aetna	11642	professional	13	33.08	108.71	154.49	137.2%
Aetna	11643	professional	13	41.54	128.46	187.44	160.8%
Aetna	14040	professional	13	97.04	318.67	477.6	65.1%
Aetna	14041	professional	13	118	387.26	580.33	70.9%
Aetna	14060	professional	13	100.33	329.46	494.18	62.6%
Aetna	14061	professional	13	132.57	417.91	623.89	77.2%
Aetna	15823	professional	13	87.3	264.73	397.09	49.8%
Aetna	19296	professional	13	249.95	1160.5	1501.93	39.9%
Aetna	19298	professional	13	79.47	405.14	540.19	13.2%
Aetna	20526	professional	13	10.6	34.92	56.67	213.2%
Aetna	20550	professional	13	7.26	24.15	44.33	229.3%
Aetna	20551	professional	13	7.26	24.15	39.5	226.9%
Aetna	20552	professional	13	6.7	22.23	36.95	249.8%
Aetna	20553	professional	13	7.74	25.74	42.43	242.2%
Aetna	20600	professional	13	6.58	21.83	40.14	213.8%
Aetna	20604	professional	13	9.45	31.08	48.4	148.2%
Aetna	20605	professional	13	6.92	23.06	42.82	222.9%
Aetna	20606	professional	13	10.45	34.35	53.53	152.5%
Aetna	20610	professional	13	8.23	27.44	48.51	222.4%
Aetna	20611	professional	13	11.99	39.22	61.2	177.1%
Aetna	20680	professional	13	85.01	257.06	386.33	48.1%
Aetna	21315	professional	13	16.6	54.18	79.03	22%
Aetna	21320	professional	13	25.8	81.36	116.14	14.6%
Aetna	21555	professional	13	63.32	187.67	281.58	62.2%
Aetna	22510	professional	13	174.6	560.72	826.9	67.1%
Aetna	22511	professional	13	171.9	550.31	813.75	66%
Aetna	22513	professional	13	487.3	1461.1	2133.56	63%
Aetna	22514	professional	13	482.74	1453.41	2110.8	63%
Aetna	22551	professional	13	1250.87	1307.55	1603.63	18%
Aetna	22558	professional	13	242.79	809.29	1145.82	7.9%
Aetna	22600	professional	13	210.85	702.84	989.52	10.7%
Aetna	22612	professional	13	252.25	840.84	1186.93	11.8%
Aetna	22630	professional	13	254.06	846.86	1185.6	7.6%
Aetna	22800	professional	13	217.38	724.59	1086.88	10.7%
Aetna	22802	professional	13	337.03	1123.45	1585.88	14.5%
Aetna	22804	professional	13	386.44	1288.15	1803.4	16.7%
Aetna	22810	professional	13	309.38	1031.25	1471.79	14%
Aetna	22812	professional	13	338.82	1129.4	1611.81	15.4%
Aetna	22849	professional	13	208.99	696.63	1044.95	15.1%
Aetna	22850	professional	13	116.99	389.96	584.94	21.4%
Aetna	22852	professional	13	112.44	374.8	562.19	21%
Aetna	22855	professional	13	177.98	593.25	889.88	32.1%
Aetna	22856	professional	13	1215.77	1288.88	1603.63	12.4%
Aetna	22861	professional	13	1689.21	1806.71	2092.03	18.3%
Aetna	23472	professional	13	221.97	739.91	1072.75	10.4%
Aetna	24500	professional	13	57.76	178.69	268.03	310%
Aetna	24505	professional	13	73.78	245.93	368.9	57%
Aetna	25600	professional	13	55.28	169.35	254.02	346.7%
Aetna	25605	professional	13	83.32	271.54	407.31	63.9%
Aetna	25607	professional	13	530.29	568.16	803.96	17.7%
Aetna	25608	professional	13	592.99	635.35	855.22	17.7%
Aetna	25609	professional	13	752.26	806	1074.66	21.4%
Aetna	26055	professional	13	73.42	225.18	330.42	67.4%
Aetna	26160	professional	13	77.89	237.83	349.89	69.5%
Aetna	26600	professional	13	49.01	150.32	225.47	227.1%
Aetna	27130	professional	13	197.88	659.61	981.19	13.7%
Aetna	27134	professional	13	293.5	978.34	1396.4	19.9%
Aetna	27236	professional	13	183.35	611.17	886.74	25%
Aetna	27245	professional	13	188.48	628.28	911.3	26%
Aetna	27278	professional	13	882.03	1179.17	3451.1	15.5%
Aetna	27279	professional	13	126.04	420.14	630.21	5.8%
Aetna	27280	professional	13	217.67	725.56	1088.33	10.5%
Aetna	27446	professional	13	176.52	588.41	873.37	12.8%
Aetna	27447	professional	13	197.65	658.83	980.07	14%
Aetna	27486	professional	13	215.95	719.85	1079.77	21.2%
Aetna	27487	professional	13	269.75	899.17	1299.17	12.2%
Aetna	27750	professional	13	55.53	172.03	258.04	304.4%
Aetna	27752	professional	13	79.42	264.75	397.12	60.7%
Aetna	27786	professional	13	49.83	153.63	230.35	276.7%
Aetna	27808	professional	13	53.21	164.01	245.58	292.7%
Aetna	27816	professional	13	48.76	161.73	239.65	269.5%
Aetna	28470	professional	13	34.89	105.75	158.19	205.3%
Aetna	29805	professional	13	71.89	239.63	359.45	41.5%
Aetna	29806	professional	13	162.34	541.12	788.52	29.3%
Aetna	29807	professional	13	158.8	529.34	771.65	28.6%
Aetna	29819	professional	13	90.08	300.27	450.4	42.6%
Aetna	29820	professional	13	81.82	272.73	409.1	18.2%
Aetna	29821	professional	13	91.2	304	455.99	42.8%
Aetna	29822	professional	13	84.47	276.62	413.06	41.1%
Aetna	29823	professional	13	91.05	303.49	452.69	42.8%
Aetna	29824	professional	13	103.92	346.39	516.85	45.4%
Aetna	29825	professional	13	90.08	300.27	450.4	42.6%
Aetna	29827	professional	13	164.11	547.04	814.83	29.6%
Aetna	29828	professional	13	655.78	702.62	936.83	25.4%
Aetna	29870	professional	13	81.49	242.36	364.23	33.5%
Aetna	29873	professional	13	83.63	272.89	408.84	40.9%
Aetna	29874	professional	13	82.2	273.99	410.99	41%
Aetna	29875	professional	13	79.4	254.09	379.3	39.8%
Aetna	29876	professional	13	100.21	334.02	501.03	44.6%
Aetna	29877	professional	13	95.4	318.01	474.18	50.2%
Aetna	29879	professional	13	101.65	338.84	505.02	44.9%
Aetna	29880	professional	13	86.98	287.79	429.37	41.8%
Aetna	29881	professional	13	84.47	276.62	413.06	48.7%
Aetna	29882	professional	13	105.89	352.96	526.08	45.8%
Aetna	29888	professional	13	149.56	498.54	742.77	20.7%
Aetna	29889	professional	13	188.2	627.33	913.57	12.1%
Aetna	29891	professional	13	101.43	338.1	507.14	44.9%
Aetna	29894	professional	13	75.15	250.49	375.74	39.5%
Aetna	29895	professional	13	69.95	232.7	349.04	38.5%
Aetna	29914	professional	13	711.23	762.03	1016.04	27.5%
Aetna	29915	professional	13	728.61	780.65	1040.87	28.2%
Aetna	29916	professional	13	729.28	781.37	1041.83	28.2%
Aetna	30115	professional	13	82.93	264.48	396.72	48.9%
Aetna	30130	professional	13	73.93	234.76	352.14	42.9%
Aetna	30140	professional	13	41.83	134.22	201.32	25.4%
Aetna	30420	professional	13	250.09	825.46	1219.44	54%
Aetna	30450	professional	13	309.52	1001.58	1444.41	61.2%
Aetna	30465	professional	13	176.87	583.82	875.73	38.6%
Aetna	30468	professional	13	224.87	681.12	1124.35	35.8%
Aetna	30469	professional	13	217.75	658.98	1088.77	35.9%
Aetna	30520	professional	13	115.81	381.83	572.75	55.8%
Aetna	30801	professional	13	32.36	103.73	155.59	38.6%
Aetna	30802	professional	13	42.29	135.08	202.62	53%
Aetna	30903	professional	13	27.42	84.68	137.07	351.7%
Aetna	30905	professional	13	38.74	122.02	193.71	502.3%
Aetna	30906	professional	13	42.75	132.71	213.73	302.8%
Aetna	31231	professional	13	21.31	67.97	106.54	181.9%
Aetna	31237	professional	13	35.19	109.12	175.94	40.8%
Aetna	31238	professional	13	35.28	109.36	176.37	45.6%

Median rate by payer, percent of Medicare

Solid line 100% of Medicare.

How this is measured

Rates come from each payer's published Transparency in Coverage machine-readable file, filtered to this specialty's codes and to NPIs the CMS Medicare utilization file shows billing that code. Percentiles are computed per payer, code and site of service across those NPIs, then divided by the locality-adjusted Medicare amount for the same code and place. Full methodology.

Payer files: 2026-09

Questions

Is this what the practice was paid?

No. These are contracted rates as published by the payer, not allowed or paid amounts.

Why are some cells blank?

Ghost rates are removed using Medicare utilization. A row appears only if that NPI billed the code.

What is an episode total?

Professional plus facility when both exist. We never average them or invent a total from one side.

Saran Siva

Co-founder & CTO, Insight Health · September 2026 files