CPT 67042 · professional fee

Vit for macular hole (CPT 67042): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 67042, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$1,494

P10 to P90: $1,058 to $2,778

vs Medicare

156%

non-facility rate $954.60

Payer spread

1.14×

BCBS $1,578 vs Aetna $1,382

State spread

4.9×

AK $4,564 to FL $930

4,623 sampled providers6,405 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 67042 in the files analyzed, at $1,578, 14% above Aetna ($1,382), the lowest of the 4 payers shown.

The state spread is 4.9×: Alaska has the highest median at $4,564 and Florida the lowest at $930, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 156% of the Medicare non-facility rate ($954.60), which ranks 103rd of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $566) and widest within UnitedHealthcare ($939).

This is a top-25 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	$1,578	$1,318	$2,070	+6%	1	3,451	165% of Medicare
Cigna	$1,505	$1,164	$2,054	+1%	2	3,761	158% of Medicare
UnitedHealthcare	$1,467	$1,188	$2,127	-2%	3	3,832	154% of Medicare
Aetna	$1,382	$1,189	$1,755	-7%	4	2,664	145% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($954.60)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$4,564	+206%	n/a	n/a	23
2	Nebraska	$2,676	+79%	Cigna	BCBS	70
3	South Dakota	$2,437	+63%	Cigna	UHC	39
4	Oregon	$2,319	+55%	UHC	Aetna	100
5	Wisconsin	$2,231	+49%	UHC	Aetna	84
6	Alabama	$2,194	+47%	BCBS	UHC	111
7	Connecticut	$2,160	+45%	Cigna	Aetna	109
8	North Dakota	$2,150	+44%	BCBS	Aetna	33
9	Iowa	$2,088	+40%	UHC	Aetna	93
10	New Mexico	$1,992	+33%	UHC	BCBS	73
11	Mississippi	$1,972	+32%	Aetna	UHC	103
12	Massachusetts	$1,957	+31%	Cigna	Aetna	116
13	Georgia	$1,947	+30%	Cigna	Aetna	113
14	Idaho	$1,893	+27%	Aetna	Cigna	57
15	Minnesota	$1,796	+20%	BCBS	Aetna	94
16	Montana	$1,778	+19%	UHC	Cigna	36
17	Maine	$1,749	+17%	Aetna	UHC	64
18	Washington	$1,711	+15%	Aetna	Cigna	120
19	West Virginia	$1,704	+14%	UHC	BCBS	76
20	Colorado	$1,656	+11%	BCBS	Aetna	103
21	Vermont	$1,652	+11%	Cigna	BCBS	33
22	Illinois	$1,645	+10%	BCBS	Aetna	111
23	New Hampshire	$1,605	+7%	UHC	Aetna	55
24	North Carolina	$1,578	+6%	BCBS	Aetna	118
24	Michigan	$1,578	+6%	BCBS	Aetna	112
26	Utah	$1,544	+3%	Cigna	UHC	115
27	Rhode Island	$1,517	+2%	Cigna	UHC	62
28	Arkansas	$1,507	+1%	Cigna	UHC	91
29	Hawaii	$1,441	-4%	Cigna	UHC	85
30	South Carolina	$1,382	-7%	BCBS	UHC	101
31	Kansas	$1,381	-8%	BCBS	Cigna	106
32	Ohio	$1,374	-8%	BCBS	Aetna	109
33	Tennessee	$1,371	-8%	BCBS	Cigna	119
34	Kentucky	$1,358	-9%	Cigna	Aetna	112
34	Indiana	$1,358	-9%	BCBS	Aetna	115
36	Louisiana	$1,318	-12%	Aetna	UHC	109
37	California	$1,309	-12%	Cigna	UHC	121
38	District of Columbia	$1,299	-13%	Aetna	BCBS	52
38	Maryland	$1,299	-13%	Aetna	BCBS	105
40	Missouri	$1,278	-14%	UHC	Cigna	110
41	Oklahoma	$1,275	-15%	BCBS	UHC	111
42	Arizona	$1,265	-15%	BCBS	Cigna	108
43	New York	$1,264	-15%	Aetna	Cigna	109
44	Texas	$1,259	-16%	Aetna	Cigna	122
45	New Jersey	$1,226	-18%	Aetna	Cigna	117
46	Virginia	$1,222	-18%	Aetna	Cigna	106
47	Nevada	$1,215	-19%	BCBS	Aetna	111
48	Delaware	$1,189	-20%	Aetna	Cigna	47
49	Pennsylvania	$1,186	-21%	UHC	Aetna	116
50	Florida	$930	-38%	UHC	Aetna	111

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 67042?

In the files we analyzed, Blue Cross Blue Shield, at a median of $1,578 across 3,451 sampled providers. Aetna is lowest at $1,382, 14% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 156% of the 2026 Medicare non-facility rate of $954.60.

Which state has the highest median for CPT 67042?

Alaska has the highest median at $4,564; Florida has the lowest at $930.

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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