Estimate patient costs

Our provider cost estimator tool helps your office estimate how much your patients will owe for an office visit or procedure. And it approximates how much Aetna will pay for services. Plus, you can use it prior to a patient’s scheduled appointment or procedure.

Patient cost estimator is available on our provider portal on Availity.
Log in to our provider portal

After entering basic patient and claims information, the cost estimator uses your fee schedule and your patients’ benefits plans to:

• Show you our estimated payment to you
• Deliver estimates of patient copayments, coinsurance and deductibles
• Help you initiate financial discussions with patients prior to, or at the time of, care
• Reduce, and potentially eliminate, financial surprises for you and your patients

Physician fee schedule tool

This tool provides fee information for a sample scope of services that a doctor can provide. Contracted physicians can access fee schedules online on our secure provider website.* Fees displayed are based on contracted amounts negotiated for specified treatments. They reflect the amounts allowed for services as if Aetna is paying each ASA/CPT/HCPCS code on a line-by-line, fee-for-service basis.

Note that physician fee schedule information will not display accurate rates for care services provided to Aetna members who participate in an accountable care organization (ACO) arrangement. A member with an ACO arrangement will have a member ID card with an ACO logo and/or network name. Providers should use the provider payment estimator tool to estimate costs for these patients.
Access our physician fee schedules

*Fee schedules are not available to an office classified as a hospital, ancillary or IPA/PHO; to an office with a billing set-up; or to behavioral health providers who are not MDs/DOs.