Payer contract guide
Official sources linked below
Negotiating with Aetna: Fee Schedule and Reimbursement Rate Benchmarks for 2026
Aetna is a CVS Health company that offers coverage through several legal entities and networks. PayerPrice's Aetna group also contains records from First Health, Banner Health, and Meritain. PayerPrice structures the published Aetna rate records it tracks so contract teams can compare the same plan, market, and provider type.
Aetna
CVS Health company with commercial and Medicare products
Plans tracked
Provider records
Rate observations
MRF publication cadence
Monthly
Oldest included refresh
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Aetna Overview
Aetna, at a glance
Aetna is a CVS Health company that offers coverage through several legal entities and networks. PayerPrice's Aetna group also contains records from First Health, Banner Health, and Meritain.
Before benchmarking an Aetna contract, match the rate to the entity and network named in the agreement and member product. Combining unrelated network records can produce a benchmark that does not represent the contract under review.
Payer sources
Aetna: About UsAetna reimbursement can vary by product, network, provider contract, service details, and geographic location. Match those attributes before relying on a parent-brand benchmark.
Quick Facts
OFFICIAL PAYER + PAYERPRICE DATA
| Payer Type | National commercial payer (CVS Health) |
| Total Membership | |
| Market Share | |
| Plan Types | Employer-sponsored Individual & Family Medicare Medicaid |
| Plans Tracked in PayerPrice | |
| Data Source | Machine Readable Files (TiC Rule) |
| Data Freshness | Updated monthly |
Negotiation Playbook
How to negotiate better Aetna reimbursement rates
Use these four steps to check the current contract, choose comparable rates, and prepare a specific proposal for Aetna.
Step 1
Benchmark your current rates
Start with the executed contract and recent remittances. Confirm which rates are in use before comparing them with published data.
Step 2
Prioritize material services
Use paid claims to find the services that matter most financially. The priority list should reflect your practice, not an arbitrary number of codes.
Step 3
Build a comparable peer set
Compare published rates from the same plan and market for similar providers. Use them as context; they do not prove what another provider was paid on a specific claim.
Step 4
Build the negotiation case
Show the current terms, matched benchmarks, expected financial effect, and proposed rates. Spell out any assumptions.
Build a proposal the payer can evaluate.
Match published rates to the contract's network and market, then apply your own service mix to estimate the financial effect.
See our full payer contract negotiations guide for the deep dive.
Aetna Network Directory
Aetna plans and entities in PayerPrice
The index keeps each Aetna partner network separate. Open a payer page to review the plan and rate data available for that entity.
Plan / Affiliate | State(s) | Plans Tracked | Providers (NPI) | |
|---|---|---|---|---|
Reimbursement Rates · National Avg.
Aetna rates for commonly billed CPT codes
These national-average in-network rates come from the latest available PayerPrice dataset. The table also shows the Medicare allowed amount for each selected CPT code. The provider contract and claim details determine the actual reimbursement.
| CPT | Description | Category | Aetna National Avg. | Medicare Benchmark | |
|---|---|---|---|---|---|
| 99214 | Office Visit, Established (Moderate) | E&M | View rates | ||
| 99213 | Office Visit, Established (Low) | E&M | View rates | ||
| 99215 | Office Visit, Established (High) | E&M | View rates | ||
| 90837 | Psychotherapy, 60 min | Psychiatry | View rates | ||
| 90834 | Psychotherapy, 45 min | Psychiatry | View rates | ||
| 90791 | Psychiatric Diagnostic Evaluation | Psychiatry | View rates | ||
| 70450 | CT Head/Brain without Contrast | Radiology | View rates | ||
| 73721 | MRI Lower Extremity Joint | Radiology | View rates | ||
| 45378 | Diagnostic Colonoscopy | Surgery | View rates |
Rates shown are national averages. Actual Aetna reimbursement varies by partner network, plan, geographic location, and provider contract. For provider-level detail by NPI or Tax ID, run a free sample report.
Aetna Machine Readable Files
How to read Aetna machine-readable files
Under the Transparency in Coverage requirements, most non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage must publish machine-readable files with in-network negotiated rates and out-of-network allowed amounts and billed charges. See the CMS guidance for plans and issuers. CMS's technical clarification states that the files are updated monthly.
For Aetna, this gets complicated fast. The Aetna grouping in PayerPrice includes multiple payer sources. Use the specific contracting entity and network when selecting a comparison set.
PayerPrice makes the Aetna records it tracks searchable by billing code, provider, plan, and market.
Search Aetna rates without opening raw filesrate observations in latest dataset
Frequently asked
Common questions about Aetna fee schedules
A Aetna fee schedule sets reimbursement terms for covered services in a provider agreement. The contract may use code-based prices or another payment method. Because Aetna contracts through multiple entities, rates can vary by partner network, product, network, and provider contract. PayerPrice organizes the published Aetna rate records it tracks for comparison.
For Aetna contract leads
Compare published Aetna rates for similar providers.
Start with a sample of published Aetna rate data, then narrow the comparison by plan, market, billing code, and provider attributes.
Your sample includes
Published rate records from Aetna
CPT and Medicare comparisons, where available
Filters for plan, market, and provider
Guidance for reading machine-readable files