What does aetna pay orthopedics groups in OR?

Median published rate is 118.6% of Medicare across 176 NPIs (September 2026 files).

Data as of the September 2026 payer files.

Across 200 procedure codes and 1 payer, the median published rate is 129 percent of locality-adjusted Medicare in the September 2026 payer files. Aetna is the only payer with enough confirmed NPIs to publish here, at 129 percent of Medicare, so there is no spread to compare yet. The best-covered row rests on 176 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 orthopedics groups in OR?
Payer	Code	Site	n	p25	p50	p75	% of Medicare
Aetna	99213	professional	176	53	71.55	111.62	118.6%
Aetna	99214	professional	165	53	79.5	155.71	108%
Aetna	99204	professional	148	53	91.71	236.61	127.3%
Aetna	99203	professional	119	53	79.5	150.96	114.3%
Aetna	20610	professional	111	51	63.26	86.22	140.2%
Aetna	99212	professional	73	51.79	53	70.01	90%
Aetna	27447	professional	71	82.42	879.16	1817.55	191.8%
Aetna	73030	professional	68	18.21	47.56	53.5	147.1%
Aetna	73502	professional	62	21.46	52.11	69.01	140.9%
Aetna	73564	professional	60	21.75	53	64.22	136.6%
Aetna	27130	professional	57	80.47	894.52	1789.04	159.7%
Aetna	73562	professional	53	20.77	53	63.52	161.2%
Aetna	20550	professional	40	50.17	66.89	83.39	141.7%
Aetna	73560	professional	34	16.32	40.01	53	140.6%
Aetna	20600	professional	33	42.1	61.73	83.33	147%
Aetna	23472	professional	31	155.95	1135.91	2272.04	160.7%
Aetna	73110	professional	28	16.85	53	63.59	163.4%
Aetna	20605	professional	26	50.09	64.23	85.05	160.8%
Aetna	29827	professional	26	83.39	886.76	1853.12	158.5%
Aetna	26055	professional	25	78.47	364.28	866.62	139.4%
Aetna	73610	professional	25	18.58	51.18	57.51	168.2%
Aetna	20611	professional	23	107.12	151.09	667.42	150.9%
Aetna	64721	professional	23	81.45	387.78	858.2	172.9%
Aetna	27245	professional	22	171.2	850.97	1711.99	147.7%
Aetna	73130	professional	22	17.57	53	63.59	177.9%
Aetna	99215	professional	22	64.78	210.45	244.14	119.8%
Aetna	63047	professional	21	83.39	902.66	1891.22	122.5%
Aetna	73630	professional	20	17.76	47.78	53.13	152.3%
Aetna	73721	professional	20	110.95	297.5	523.95	251.5%
Aetna	29823	professional	18	88	510.4	1173.66	165.3%
Aetna	29828	professional	18	1309.43	1737.06	1831.32	95.8%
Aetna	20680	professional	17	83.39	436.11	965.04	119.1%
Aetna	29881	professional	15	83.39	620.85	1487.83	115.3%
Aetna	73221	professional	15	107.25	276.84	561.37	286.1%
Aetna	22612	professional	14	131.79	1261.33	2344.44	24%
Aetna	27236	professional	14	109.82	1362.48	1992.65	51.3%
Aetna	99205	professional	14	56.83	107.93	308.37	123.6%
Aetna	20526	professional	13	49.54	83.39	527.48	1248.5%
Aetna	22558	professional	13	173.85	1216.92	2294.76	16.8%
Aetna	22633	professional	13	1026.68	2053.35	2549.74	14.8%
Aetna	29880	professional	13	83.39	564.3	1528.75	92.9%
Aetna	64483	professional	13	53	155.48	822.65	169.4%
Aetna	64718	professional	13	83.39	619.03	1547.67	163.1%
Aetna	22551	professional	12	2238.63	2468.52	3342.21	32.4%
Aetna	25609	professional	12	1851.73	1858.72	2061.5	49.9%
Aetna	26160	professional	12	83.39	385.39	1114.26	128.6%
Aetna	29822	professional	12	83.39	543.25	1422.43	86.5%
Aetna	29877	professional	12	83.39	623.16	1465.52	89.1%
Aetna	63030	professional	12	133	1063.98	1904.21	55.8%
Aetna	10005	professional	11	78.25	432.04	893.1	179.2%
Aetna	10021	professional	11	51	166.39	1464.41	2308.3%
Aetna	20551	professional	11	53	83.39	633.9	1888.3%
Aetna	20552	professional	11	51.45	83.39	629.54	2232.4%
Aetna	25605	professional	11	85.41	533.54	1154.66	132.3%
Aetna	27446	professional	11	147.44	1146.77	1913.71	20.8%
Aetna	28470	professional	11	83.39	212.93	779.42	575%
Aetna	29806	professional	11	136.14	1058.8	1872.53	50.7%
Aetna	29824	professional	11	91.67	679.72	1515.23	92.1%
Aetna	29888	professional	11	125.6	976.84	1805.03	37.5%
Aetna	31231	professional	11	83.39	139.93	963.77	878.3%
Aetna	31575	professional	11	83.39	107.94	885.51	955.8%
Aetna	36561	professional	11	101.22	787.2	1771.1	109.1%
Aetna	36590	professional	11	83.39	219.74	866.9	133.4%
Aetna	43235	professional	11	83.39	240.31	880.62	176.9%
Aetna	43239	professional	11	83.39	301.18	1122.88	225.5%
Aetna	43247	professional	11	83.39	328.44	1547.67	310.9%
Aetna	43249	professional	11	83.39	718.02	1547.67	173.1%
Aetna	45378	professional	11	83.39	200.79	1169.71	229.1%
Aetna	45380	professional	11	83.39	372.08	1247.24	189.9%
Aetna	45381	professional	11	83.39	377.11	1235.83	188.2%
Aetna	45385	professional	11	83.39	415.92	1304.69	198.7%
Aetna	46221	professional	11	83.39	244.91	828.56	347.7%
Aetna	52000	professional	11	83.39	193.31	815.23	262.4%
Aetna	52287	professional	11	232.07	1128.82	1659.39	165.6%
Aetna	52356	professional	11	345.55	1129.95	1460.28	48.2%
Aetna	54150	professional	11	83.39	157.67	757.41	75.6%
Aetna	54530	professional	11	87.09	572.81	1419.3	81.4%
Aetna	62322	professional	11	88.13	853.77	1469.06	301.6%
Aetna	62323	professional	11	142.65	615.38	985.18	211.4%
Aetna	64415	professional	11	83.39	120.05	698.57	143.9%
Aetna	64445	professional	11	83.39	136.53	709.83	574.6%
Aetna	64447	professional	11	79.12	105.5	231.85	266.7%
Aetna	64450	professional	11	52	83.39	678.46	1247.6%
Aetna	20553	professional	10	50.86	83.39	636.23	1933.8%
Aetna	20604	professional	10	45.78	648.3	1065.65	1184.8%
Aetna	20606	professional	10	50.46	655.59	1069.3	1135.4%
Aetna	21555	professional	10	83.39	369.58	1171.61	157.9%
Aetna	22600	professional	10	203.26	1293.46	2080.6	16.1%
Aetna	25600	professional	10	83.39	336.37	850.65	627.6%
Aetna	25607	professional	10	1138.08	1771.1	2260.38	35.6%
Aetna	26600	professional	10	83.39	298.74	584.74	465.1%
Aetna	27134	professional	10	481.38	1771.1	2071.84	23.3%
Aetna	27279	professional	10	604.82	1703.33	1832.83	13.1%
Aetna	27486	professional	10	160.22	1201.68	2192.27	32.2%
Aetna	27487	professional	10	274.81	1748.77	2520.02	18%
Aetna	27750	professional	10	83.39	340.46	901.4	665%
Aetna	27786	professional	10	83.39	261.71	874.63	645.3%
Aetna	27808	professional	10	83.39	325.29	891.39	657.7%
Aetna	29807	professional	10	162.76	1035.72	1849.99	50.1%
Aetna	29879	professional	10	106.15	663.44	1514.17	92.8%
Aetna	29882	professional	10	109.8	691.81	1552.85	95.5%
Aetna	29914	professional	10	1671.3	1849.02	2449.21	50.7%
Aetna	29916	professional	10	1691.57	1867	2484.4	50.9%
Aetna	30905	professional	10	170.62	1464.41	1473.71	1991.3%
Aetna	31237	professional	10	83.39	230.89	1089.65	129.1%
Aetna	31536	professional	10	158.1	1730	1771.1	104.4%
Aetna	31600	professional	10	83.39	312.99	1547.67	104.5%
Aetna	32555	professional	10	158.64	1219.73	1351.37	354%
Aetna	33208	professional	10	100.48	619.36	1412.44	18.3%
Aetna	33228	professional	10	314.27	1004.19	1343.37	16.1%
Aetna	33264	professional	10	358.47	1315.31	1771.1	7.1%
Aetna	36514	professional	10	277.74	1640	1659.39	194.1%
Aetna	36589	professional	10	103.94	207.87	1464.41	425%
Aetna	38222	professional	10	88.99	746.76	1114.88	59.8%
Aetna	38505	professional	10	83.39	149.64	705.84	95.1%
Aetna	38510	professional	10	83.39	441.73	1267.29	79%
Aetna	41120	professional	10	811.78	1510	1832.83	58.5%
Aetna	42400	professional	10	50.77	798.15	1469.06	2181.1%
Aetna	42415	professional	10	819.9	1516.25	1929.83	58.5%
Aetna	43251	professional	10	83.39	354.43	1547.67	173.1%
Aetna	43255	professional	10	83.39	483.5	1547.67	173.1%
Aetna	43262	professional	10	83.39	419.05	1547.67	77.9%
Aetna	43264	professional	10	83.39	427.06	1547.67	77.9%
Aetna	43274	professional	10	339.22	1342.07	1536.04	36.2%
Aetna	43275	professional	10	275.74	1262.16	1496.08	141.1%
Aetna	43762	professional	10	96.01	802.85	1142.93	582.7%
Aetna	47000	professional	10	83.39	199.77	937.44	126.3%
Aetna	49083	professional	10	146.8	1082.82	1361.41	217.5%
Aetna	50543	professional	10	249.15	1585.48	2488.05	48.6%
Aetna	51720	professional	10	69.78	83.39	704.16	1171.8%
Aetna	51725	professional	10	179.46	973.22	1469.06	1198.5%
Aetna	51728	professional	10	265.78	470.99	1157.71	496.3%
Aetna	51729	professional	10	298.62	487.32	1157.71	507.2%
Aetna	52005	professional	10	83.39	230.21	1103.75	110.2%
Aetna	52214	professional	10	236.1	1173.49	1659.39	96.3%
Aetna	52234	professional	10	83.39	260.39	1547.67	89.8%
Aetna	52235	professional	10	83.39	305.42	1196.22	69.4%
Aetna	52240	professional	10	83.39	474.17	1426.41	52.3%
Aetna	52310	professional	10	83.39	284.21	1053.06	105.1%
Aetna	52315	professional	10	83.39	451.34	1260.81	125.8%
Aetna	52317	professional	10	83.39	650.91	1464.41	85%
Aetna	52332	professional	10	83.39	335.85	1352.48	78.5%
Aetna	52352	professional	10	83.39	428.51	1283.25	74.5%
Aetna	52353	professional	10	83.39	474.17	1341.81	49.2%
Aetna	52601	professional	10	88.74	665.57	1785.35	65.4%
Aetna	52630	professional	10	247.01	655.08	1659.39	60.8%
Aetna	53854	professional	10	769.42	1659.39	1985.86	96.3%
Aetna	54161	professional	10	83.39	222.06	1547.67	154.5%
Aetna	54640	professional	10	83.39	486.29	1387.01	79.5%
Aetna	54840	professional	10	83.39	363.29	1226.33	122.4%
Aetna	55250	professional	10	83.39	315.48	1243.71	124.1%
Aetna	55866	professional	10	211.37	1345.08	2689.31	52.5%
Aetna	57260	professional	10	560.12	1771.1	1845.8	77.6%
Aetna	57287	professional	10	112.87	715.74	1637.37	95.7%
Aetna	57288	professional	10	113.12	717.68	1654.81	56.4%
Aetna	60220	professional	10	103.8	621.27	1547.67	51.1%
Aetna	60252	professional	10	189.17	1151.92	2092.75	69.2%
Aetna	60500	professional	10	138.64	844.8	1812.84	59.9%
Aetna	61885	professional	10	89.86	482.21	1547.67	5.5%
Aetna	62270	professional	10	71.09	1464.41	1473.71	378%
Aetna	62320	professional	10	97.08	1464.41	1473.71	378%
Aetna	62326	professional	10	82.84	1464.41	1473.71	301.6%
Aetna	64417	professional	10	81.44	1464.41	1473.71	301.6%
Aetna	64425	professional	10	77.88	96.49	704.15	822.6%
Aetna	64493	professional	10	471.66	754.35	1686.25	155.4%
Aetna	64568	professional	10	674.31	1547.67	1808.5	3.7%
Aetna	64585	professional	10	112.03	316.88	1464.41	73.1%
Aetna	64595	professional	10	104.15	293.43	1464.41	73.1%
Aetna	64708	professional	10	87	476.45	1547.67	163.1%
Aetna	64712	professional	10	453.26	1168.66	1659.39	174.9%
Aetna	64910	professional	10	1452.84	1659.39	1906.66	28.2%
Aetna	64912	professional	10	653.47	1640	1659.39	26.9%
Aetna	69436	professional	10	83.39	145.03	1044.29	158.4%
Aetna	72100	professional	10	21.24	55.08	71.82	186.9%
Aetna	73501	professional	10	18.36	38.91	54.55	159.5%
Aetna	92920	professional	10	329.79	1771.1	2088.55	46%
Aetna	92928	professional	10	367.55	1431.69	1899.6	19.6%
Aetna	93454	professional	10	595.12	1359.52	1807.21	111.5%
Aetna	93455	professional	10	880.58	1771.1	2318.96	117.2%
Aetna	93458	professional	10	696.11	1632.65	1997.06	125.9%
Aetna	93653	professional	10	528.06	1631.53	2121.03	9.1%
Aetna	93656	professional	10	598.79	1881.53	2243.66	9.8%
Aetna	G0105	professional	10	150.6	230.17	1070.74	209.7%
Aetna	G0121	professional	10	150.6	282.34	1070.74	209.7%
Aetna	11640	professional	9	106.62	1640	1659.39	1168.7%
Aetna	11641	professional	9	127.23	1640	1659.39	1047.3%
Aetna	11642	professional	9	83.39	182.15	1030.66	597.3%
Aetna	11643	professional	9	83.39	220.01	1073.05	560.8%
Aetna	14040	professional	9	97.78	560.82	1497.43	132.7%
Aetna	14041	professional	9	113.91	683.43	1771.1	156.9%
Aetna	14060	professional	9	99.89	581.87	1462.38	129.6%
Aetna	14061	professional	9	587.99	1730	1771.1	156.9%
Aetna	15823	professional	9	89.14	474.41	1142.51	101.2%
Aetna	19296	professional	9	1719.43	1771.1	3123.88	46.7%
Aetna	19298	professional	9	605.38	1771.1	2393.88	30.5%
Aetna	21315	professional	9	71.98	1640	1659.39	251.7%
Aetna	21320	professional	9	83.39	133.42	1028.43	69.5%
Aetna	22510	professional	9	763.87	1771.1	1834.05	107.7%
Aetna	22511	professional	9	751.08	1771.1	1834.05	107.7%
Aetna	22513	professional	9	1763.21	1771.1	2810.24	54.6%

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