CPT 65778 · professional fee

Cover eye w/membrane (CPT 65778): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 65778, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$70

P10 to P90: $45 to $122

vs Medicare

195%

facility rate $35.74

Payer spread

1.07×

UHC $73 vs BCBS $68

State spread

3.9×

AK $175 to FL $45

4,488 sampled providers6,067 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

UnitedHealthcare has the highest median for CPT 65778 in the files analyzed, at $73, 7% above Blue Cross Blue Shield ($68), the lowest of the 4 payers shown.

The state spread is 3.9×: Alaska has the highest median at $175 and Florida the lowest at $45, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 195% of the Medicare facility rate ($35.74), which ranks 40th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $24) and widest within Cigna ($45).

This is a top-19 code for ophthalmology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($1,274.24) is 35.6× higher because it includes device or supply cost that professional-fee contracts do not.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$73	$56	$102	+4%	1	3,619	204% of Medicare
Cigna	$71	$50	$95	+2%	2	3,316	199% of Medicare
Aetna	$69	$56	$80	-1%	3	2,910	193% of Medicare
Blue Cross Blue Shield	$68	$54	$88	-2%	4	3,121	191% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($35.74)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$175	+150%	n/a	n/a	24
2	Oregon	$106	+51%	UHC	Aetna	98
3	Mississippi	$95	+35%	Aetna	UHC	102
4	Connecticut	$93	+33%	Cigna	BCBS	109
5	South Dakota	$91	+31%	Cigna	BCBS	39
6	Wisconsin	$87	+24%	UHC	Aetna	82
7	Idaho	$87	+24%	Aetna	Cigna	57
8	Rhode Island	$86	+24%	Cigna	BCBS	62
9	Massachusetts	$86	+23%	UHC	Aetna	118
10	New Mexico	$85	+22%	UHC	BCBS	73
11	North Dakota	$84	+20%	UHC	Aetna	33
12	Maine	$82	+18%	UHC	Aetna	63
13	Minnesota	$82	+18%	BCBS	Aetna	93
14	California	$82	+17%	Cigna	UHC	121
15	Georgia	$81	+17%	Cigna	UHC	111
16	North Carolina	$80	+15%	BCBS	Aetna	93
16	Alabama	$80	+15%	BCBS	UHC	109
18	Nebraska	$79	+14%	Cigna	BCBS	70
18	Colorado	$79	+14%	BCBS	Aetna	101
20	Washington	$79	+13%	Aetna	Cigna	118
21	Iowa	$78	+12%	UHC	BCBS	93
22	Ohio	$77	+11%	BCBS	Aetna	109
23	Vermont	$77	+10%	UHC	Cigna	24
24	South Carolina	$73	+5%	Cigna	UHC	101
25	New Hampshire	$73	+5%	UHC	BCBS	56
26	Arkansas	$71	+2%	Cigna	Aetna	91
27	Kentucky	$70	-0%	UHC	Cigna	112
28	Michigan	$69	-1%	UHC	BCBS	112
29	Montana	$68	-2%	UHC	Cigna	34
30	West Virginia	$67	-4%	UHC	Aetna	78
31	Kansas	$66	-5%	Aetna	Cigna	105
32	Tennessee	$65	-6%	BCBS	Cigna	119
33	New York	$64	-8%	BCBS	Cigna	104
34	Utah	$64	-9%	Cigna	BCBS	97
35	Missouri	$64	-9%	BCBS	Aetna	109
36	Maryland	$62	-11%	UHC	BCBS	106
37	Louisiana	$62	-12%	Aetna	Cigna	109
38	Illinois	$62	-12%	UHC	Aetna	111
38	District of Columbia	$62	-12%	UHC	BCBS	51
40	Oklahoma	$59	-15%	BCBS	Cigna	112
41	New Jersey	$59	-15%	Aetna	Cigna	117
42	Nevada	$58	-17%	Cigna	Aetna	110
43	Hawaii	$57	-18%	n/a	n/a	21
44	Pennsylvania	$57	-19%	BCBS	Cigna	116
45	Delaware	$56	-20%	UHC	Cigna	46
46	Virginia	$55	-21%	Aetna	BCBS	104
47	Indiana	$55	-22%	UHC	Aetna	115
48	Texas	$54	-22%	UHC	BCBS	123
49	Arizona	$51	-27%	UHC	BCBS	108
50	Florida	$45	-36%	UHC	Cigna	112

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 65778?

In the files we analyzed, UnitedHealthcare, at a median of $73 across 3,619 sampled providers. Blue Cross Blue Shield is lowest at $68, 7% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 195% of the 2026 Medicare facility rate of $35.74.

Which state has the highest median for CPT 65778?

Alaska has the highest median at $175; Florida has the lowest at $45.

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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