CPT 68761 · professional fee

Close tear duct opening (CPT 68761): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 68761, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$164

P10 to P90: $114 to $322

vs Medicare

114%

non-facility rate $143.29

Payer spread

1.22×

UHC $186 vs Cigna $153

State spread

4.2×

AK $471 to FL $113

4,677 sampled providers6,433 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 68761 in the files analyzed, at $186, 22% above Cigna ($153), the lowest of the 4 payers shown.

The state spread is 4.2×: Alaska has the highest median at $471 and Florida the lowest at $113, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 114% of the Medicare non-facility rate ($143.29), which ranks 173rd of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $49) and widest within UnitedHealthcare ($121).

This is a top-16 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	$186	$145	$266	+14%	1	3,834	130% of Medicare
Blue Cross Blue Shield	$163	$127	$224	-1%	2	3,488	114% of Medicare
Aetna	$157	$131	$181	-4%	3	3,230	110% of Medicare
Cigna	$153	$121	$213	-7%	4	3,783	107% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($143.29)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$471	+187%	n/a	n/a	24
2	Wisconsin	$282	+72%	BCBS	Aetna	104
3	Nebraska	$274	+67%	UHC	Aetna	71
4	South Dakota	$264	+61%	UHC	BCBS	39
5	Iowa	$254	+55%	UHC	Aetna	93
6	Oregon	$252	+54%	UHC	Aetna	100
7	North Dakota	$243	+48%	UHC	Aetna	34
8	Idaho	$233	+42%	Aetna	Cigna	57
9	Massachusetts	$232	+41%	UHC	Aetna	118
10	Connecticut	$224	+36%	UHC	Aetna	111
11	Minnesota	$223	+36%	BCBS	Aetna	94
12	Georgia	$216	+32%	UHC	BCBS	114
13	Vermont	$207	+26%	UHC	BCBS	35
14	Washington	$199	+21%	UHC	Cigna	120
15	Mississippi	$189	+15%	BCBS	Cigna	103
16	Hawaii	$189	+15%	UHC	Cigna	85
17	Maine	$184	+12%	UHC	Aetna	64
18	Montana	$184	+12%	UHC	BCBS	36
19	New Hampshire	$183	+11%	UHC	Aetna	56
20	Rhode Island	$181	+10%	Cigna	Aetna	62
21	Colorado	$177	+8%	UHC	Cigna	104
22	Illinois	$174	+6%	UHC	Aetna	111
23	Kansas	$172	+5%	UHC	Cigna	106
24	New Mexico	$170	+4%	UHC	BCBS	74
25	Tennessee	$160	-2%	UHC	Cigna	120
26	Arkansas	$159	-3%	UHC	Aetna	92
27	West Virginia	$157	-4%	UHC	BCBS	78
28	Louisiana	$156	-5%	Aetna	Cigna	109
29	Michigan	$156	-5%	UHC	BCBS	112
30	New York	$156	-5%	UHC	Cigna	110
31	Nevada	$151	-8%	UHC	BCBS	112
32	North Carolina	$149	-9%	UHC	Aetna	118
33	Oklahoma	$148	-10%	UHC	Aetna	112
34	Ohio	$148	-10%	UHC	BCBS	111
35	Utah	$148	-10%	BCBS	Cigna	116
36	South Carolina	$146	-11%	Aetna	Cigna	103
37	Kentucky	$145	-12%	Cigna	BCBS	112
38	Texas	$143	-13%	UHC	Cigna	123
39	District of Columbia	$141	-14%	Aetna	BCBS	52
40	Alabama	$141	-14%	Aetna	BCBS	111
41	Missouri	$141	-14%	UHC	Cigna	110
42	Maryland	$140	-15%	Aetna	BCBS	106
43	Pennsylvania	$140	-15%	UHC	Cigna	117
44	Virginia	$133	-19%	Aetna	Cigna	109
45	New Jersey	$131	-20%	Aetna	Cigna	117
46	Delaware	$131	-20%	Aetna	Cigna	47
47	Indiana	$131	-20%	UHC	BCBS	115
48	California	$130	-21%	UHC	BCBS	122
49	Arizona	$125	-24%	UHC	BCBS	109
50	Florida	$113	-31%	UHC	Cigna	112

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 68761?

In the files we analyzed, UnitedHealthcare, at a median of $186 across 3,834 sampled providers. Cigna is lowest at $153, 22% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 114% of the 2026 Medicare non-facility rate of $143.29.

Which state has the highest median for CPT 68761?

Alaska has the highest median at $471; Florida has the lowest at $113.

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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