CPT 67904 · professional fee

Repair eyelid defect (CPT 67904): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 67904, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$816

P10 to P90: $561 to $1,632

vs Medicare

110%

non-facility rate $744.84

Payer spread

1.27×

UHC $912 vs Aetna $717

State spread

4.3×

AK $2,388 to FL $558

4,649 sampled providers6,416 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 67904 in the files analyzed, at $912, 27% above Aetna ($717), the lowest of the 4 payers shown.

The state spread is 4.3×: Alaska has the highest median at $2,388 and Florida the lowest at $558, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 110% of the Medicare non-facility rate ($744.84), which ranks 176th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $295) and widest within UnitedHealthcare ($591).

This is a top-23 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
UnitedHealthcare	$912	$717	$1,308	+12%	1	3,834	122% of Medicare
Blue Cross Blue Shield	$874	$693	$1,178	+7%	2	3,491	117% of Medicare
Cigna	$759	$611	$1,057	-7%	3	3,783	102% of Medicare
Aetna	$717	$620	$915	-12%	4	2,696	96% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($744.84)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$2,388	+193%	n/a	n/a	23
2	Wisconsin	$1,448	+77%	BCBS	Aetna	104
3	Nebraska	$1,384	+70%	UHC	BCBS	70
4	South Dakota	$1,347	+65%	UHC	BCBS	39
5	Oregon	$1,339	+64%	UHC	Aetna	100
6	Iowa	$1,247	+53%	UHC	BCBS	93
7	North Dakota	$1,192	+46%	UHC	Aetna	33
8	Idaho	$1,155	+41%	Aetna	Cigna	57
9	Massachusetts	$1,139	+40%	UHC	Aetna	116
10	Alabama	$1,135	+39%	Aetna	Cigna	111
11	Minnesota	$1,110	+36%	BCBS	Aetna	94
12	Georgia	$1,109	+36%	UHC	BCBS	114
13	Mississippi	$1,027	+26%	BCBS	Cigna	103
14	Vermont	$1,021	+25%	UHC	BCBS	33
15	Washington	$1,006	+23%	UHC	Cigna	119
16	Connecticut	$997	+22%	UHC	Cigna	110
17	New Hampshire	$969	+19%	UHC	Aetna	55
18	Hawaii	$955	+17%	UHC	Cigna	85
19	Montana	$930	+14%	UHC	Cigna	36
20	Maine	$919	+13%	UHC	Cigna	64
21	Kansas	$884	+8%	BCBS	Aetna	106
22	Colorado	$877	+7%	UHC	Aetna	104
23	Illinois	$874	+7%	UHC	Aetna	111
24	New Mexico	$864	+6%	UHC	BCBS	74
25	Michigan	$835	+2%	UHC	Aetna	112
26	Utah	$830	+2%	BCBS	Aetna	115
27	Tennessee	$795	-3%	UHC	Cigna	121
28	Louisiana	$771	-6%	Aetna	Cigna	109
29	New York	$763	-7%	BCBS	Cigna	109
30	Rhode Island	$759	-7%	Cigna	Aetna	62
31	Oklahoma	$754	-8%	UHC	Aetna	111
32	Indiana	$749	-8%	BCBS	Aetna	115
33	Kentucky	$740	-9%	UHC	Aetna	112
34	West Virginia	$739	-9%	UHC	BCBS	76
35	Ohio	$732	-10%	UHC	Aetna	109
36	Arkansas	$727	-11%	UHC	Aetna	91
37	North Carolina	$717	-12%	UHC	BCBS	118
38	Missouri	$714	-12%	UHC	Cigna	109
39	Texas	$709	-13%	UHC	Cigna	123
40	South Carolina	$705	-14%	UHC	Cigna	102
41	Nevada	$699	-14%	UHC	Aetna	111
42	Maryland	$699	-14%	Aetna	BCBS	105
42	District of Columbia	$699	-14%	Aetna	BCBS	52
44	Pennsylvania	$691	-15%	UHC	Cigna	116
45	Virginia	$660	-19%	UHC	Cigna	106
46	Delaware	$632	-23%	UHC	Aetna	47
47	New Jersey	$629	-23%	UHC	BCBS	117
48	Arizona	$618	-24%	UHC	BCBS	108
49	California	$611	-25%	UHC	BCBS	121
50	Florida	$558	-32%	UHC	Aetna	111

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 67904?

In the files we analyzed, UnitedHealthcare, at a median of $912 across 3,834 sampled providers. Aetna is lowest at $717, 27% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 110% of the 2026 Medicare non-facility rate of $744.84.

Which state has the highest median for CPT 67904?

Alaska has the highest median at $2,388; Florida has the lowest at $558.

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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