CPT 76512 · professional fee

Oph us dx b-scan (CPT 76512): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 76512, 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: $41 to $140

vs Medicare

144%

non-facility rate $48.77

Payer spread

1.30×

Cigna $77 vs Aetna $60

State spread

5.2×

AK $182 to FL $35

4,633 sampled providers6,142 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

Cigna has the highest median for CPT 76512 in the files analyzed, at $77, 30% above Aetna ($60), the lowest of the 4 payers shown.

The state spread is 5.2×: Alaska has the highest median at $182 and Florida the lowest at $35, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 144% of the Medicare non-facility rate ($48.77), which ranks 135th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $26) and widest within Cigna ($59).

This is a top-37 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
Cigna	$77	$52	$111	+11%	1	3,704	159% of Medicare
Blue Cross Blue Shield	$76	$53	$105	+9%	2	3,327	156% of Medicare
UnitedHealthcare	$65	$54	$99	-8%	3	3,834	132% of Medicare
Aetna	$60	$46	$72	-15%	4	3,184	122% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($48.77)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$182	+160%	n/a	n/a	24
2	South Dakota	$103	+47%	Cigna	BCBS	39
3	Connecticut	$102	+45%	Cigna	BCBS	111
4	Alabama	$99	+41%	BCBS	UHC	109
5	Wisconsin	$98	+40%	BCBS	Cigna	98
6	Nebraska	$96	+38%	Cigna	Aetna	71
7	Mississippi	$95	+36%	BCBS	UHC	103
8	Idaho	$93	+33%	BCBS	Cigna	57
9	North Dakota	$92	+32%	BCBS	Aetna	33
10	Iowa	$90	+28%	Cigna	Aetna	93
11	California	$90	+28%	Cigna	UHC	121
12	Georgia	$88	+26%	Cigna	Aetna	114
13	Oregon	$84	+20%	UHC	Aetna	100
14	North Carolina	$79	+13%	Cigna	Aetna	100
15	Colorado	$79	+13%	UHC	Aetna	102
16	Montana	$76	+8%	UHC	BCBS	36
17	Arkansas	$76	+8%	Cigna	UHC	92
18	Massachusetts	$74	+6%	UHC	BCBS	111
19	Ohio	$73	+4%	BCBS	Aetna	110
20	Utah	$72	+3%	Cigna	UHC	116
20	Delaware	$72	+3%	Cigna	Aetna	47
22	Vermont	$72	+3%	UHC	BCBS	35
23	Michigan	$72	+2%	UHC	Aetna	112
24	Rhode Island	$71	+1%	UHC	BCBS	62
25	Indiana	$71	+1%	BCBS	Aetna	115
26	New Hampshire	$70	+0%	Aetna	Cigna	56
27	Illinois	$68	-3%	UHC	BCBS	111
28	New York	$68	-3%	BCBS	UHC	109
29	Hawaii	$68	-3%	BCBS	Cigna	89
30	Washington	$66	-6%	Cigna	UHC	120
31	New Mexico	$65	-7%	Cigna	BCBS	74
32	Minnesota	$65	-8%	BCBS	Aetna	95
33	South Carolina	$62	-11%	Cigna	Aetna	102
34	New Jersey	$62	-12%	Aetna	UHC	116
35	Kentucky	$61	-13%	UHC	Aetna	112
36	Maine	$61	-13%	UHC	Aetna	63
37	West Virginia	$60	-15%	UHC	Aetna	78
38	Missouri	$59	-16%	UHC	Aetna	110
39	Tennessee	$58	-17%	BCBS	Cigna	119
40	Louisiana	$57	-18%	Aetna	Cigna	109
41	Kansas	$56	-20%	BCBS	Aetna	106
42	Nevada	$54	-23%	Cigna	Aetna	112
43	Virginia	$53	-24%	Aetna	Cigna	107
44	Pennsylvania	$51	-27%	Cigna	BCBS	117
45	District of Columbia	$50	-29%	Cigna	BCBS	51
46	Arizona	$50	-29%	UHC	BCBS	108
47	Maryland	$47	-33%	UHC	BCBS	105
48	Texas	$45	-36%	UHC	BCBS	122
49	Oklahoma	$41	-41%	UHC	Aetna	112
50	Florida	$35	-50%	UHC	Aetna	112

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 76512?

In the files we analyzed, Cigna, at a median of $77 across 3,704 sampled providers. Aetna is lowest at $60, 30% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 144% of the 2026 Medicare non-facility rate of $48.77.

Which state has the highest median for CPT 76512?

Alaska has the highest median at $182; Florida has the lowest at $35.

Is this a professional fee?

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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