CPT 15823 · professional fee

Blepharp upr eyelid xcsv skn (CPT 15823): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 15823, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$677

P10 to P90: $492 to $1,336

vs Medicare

107%

non-facility rate $632.95

Payer spread

1.36×

BCBS $760 vs Aetna $560

State spread

4.5×

AK $2,230 to FL $494

4,651 sampled providers6,423 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

Blue Cross Blue Shield has the highest median for CPT 15823 in the files analyzed, at $760, 36% above Aetna ($560), the lowest of the 4 payers shown.

The state spread is 4.5×: Alaska has the highest median at $2,230 and Florida the lowest at $494, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 107% of the Medicare non-facility rate ($632.95), which ranks 184th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $183) and widest within UnitedHealthcare ($481).

This is a top-18 code for ophthalmology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
Blue Cross Blue Shield	$760	$613	$1,034	+12%	1	3,490	120% of Medicare
UnitedHealthcare	$755	$596	$1,077	+12%	2	3,834	119% of Medicare
Cigna	$659	$527	$908	-3%	3	3,783	104% of Medicare
Aetna	$560	$498	$681	-17%	4	2,832	89% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($632.95)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$2,230	+229%	n/a	n/a	23
2	Nebraska	$1,261	+86%	Cigna	BCBS	70
3	Wisconsin	$1,208	+78%	BCBS	Aetna	104
4	South Dakota	$1,169	+73%	Cigna	BCBS	39
5	North Dakota	$1,130	+67%	BCBS	Aetna	33
6	Oregon	$1,116	+65%	UHC	Aetna	100
7	Iowa	$1,063	+57%	Cigna	Aetna	93
8	Minnesota	$953	+41%	BCBS	Aetna	94
9	Georgia	$922	+36%	UHC	Aetna	115
10	Massachusetts	$894	+32%	UHC	Aetna	116
11	Montana	$869	+28%	UHC	Cigna	36
12	Washington	$844	+25%	UHC	Cigna	120
13	Idaho	$839	+24%	BCBS	Cigna	57
14	Mississippi	$825	+22%	BCBS	UHC	103
15	Hawaii	$808	+19%	UHC	Cigna	85
16	Colorado	$792	+17%	UHC	Aetna	104
17	New Hampshire	$784	+16%	UHC	Aetna	55
18	Vermont	$778	+15%	UHC	Cigna	33
19	Connecticut	$765	+13%	UHC	Aetna	110
20	Michigan	$755	+12%	BCBS	Aetna	112
21	New Mexico	$754	+11%	UHC	Aetna	71
22	Illinois	$718	+6%	Cigna	Aetna	111
23	Utah	$677	+0%	Cigna	Aetna	116
24	Indiana	$656	-3%	BCBS	Aetna	115
25	Tennessee	$644	-5%	BCBS	Cigna	121
26	Kansas	$639	-6%	BCBS	Aetna	106
27	Kentucky	$629	-7%	Cigna	Aetna	112
27	Oklahoma	$629	-7%	BCBS	Aetna	111
27	Ohio	$629	-7%	UHC	Aetna	109
30	Maine	$624	-8%	UHC	Aetna	64
31	Texas	$624	-8%	UHC	Aetna	123
32	Virginia	$617	-9%	BCBS	Cigna	106
32	North Carolina	$617	-9%	UHC	Aetna	118
34	Missouri	$616	-9%	BCBS	Aetna	110
35	Alabama	$598	-12%	BCBS	Cigna	111
36	West Virginia	$596	-12%	UHC	Aetna	77
37	South Carolina	$595	-12%	UHC	Cigna	102
38	Louisiana	$594	-12%	Aetna	Cigna	109
39	Arkansas	$593	-12%	UHC	Cigna	91
40	Nevada	$584	-14%	UHC	Aetna	111
41	Rhode Island	$583	-14%	UHC	BCBS	62
42	District of Columbia	$583	-14%	Cigna	BCBS	52
43	Maryland	$582	-14%	UHC	BCBS	105
44	California	$575	-15%	Cigna	BCBS	121
45	Pennsylvania	$559	-18%	BCBS	Aetna	116
46	New York	$543	-20%	UHC	Aetna	109
47	Arizona	$539	-20%	UHC	BCBS	108
48	New Jersey	$533	-21%	BCBS	Cigna	117
49	Delaware	$525	-22%	UHC	Aetna	47
50	Florida	$494	-27%	UHC	Cigna	111

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 15823?

In the files we analyzed, Blue Cross Blue Shield, at a median of $760 across 3,490 sampled providers. Aetna is lowest at $560, 36% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 107% of the 2026 Medicare non-facility rate of $632.95.

Which state has the highest median for CPT 15823?

Alaska has the highest median at $2,230; Florida has the lowest at $494.

Is this the surgeon, physician or facility payment?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

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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