CPT 92004 · professional fee

Compre oph exam new pt 1/> (CPT 92004): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 92004, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$124

P10 to P90: $80 to $257

vs Medicare

83%

non-facility rate $149.64

Payer spread

1.58×

UHC $168 vs BCBS $106

State spread

3.5×

AK $330 to NC $93

4,688 sampled providers6,975 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 92004 in the files analyzed, at $168, 58% above Blue Cross Blue Shield ($106), the lowest of the 4 payers shown.

The state spread is 3.5×: Alaska has the highest median at $330 and North Carolina the lowest at $93, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 83% of the Medicare non-facility rate ($149.64), which ranks 226th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $37) and widest within Cigna ($87).

This is a top-11 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	$168	$137	$231	+35%	1	3,834	112% of Medicare
Cigna	$123	$96	$183	-1%	2	3,783	82% of Medicare
Aetna	$106	$89	$126	-14%	3	3,397	71% of Medicare
Blue Cross Blue Shield	$106	$85	$148	-14%	4	3,847	71% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($149.64)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$330	+166%	BCBS	Aetna	24
2	Iowa	$216	+74%	Cigna	Aetna	93
3	Wisconsin	$210	+69%	UHC	Aetna	104
4	Nebraska	$196	+58%	UHC	Aetna	71
5	Oregon	$195	+57%	UHC	BCBS	100
6	Hawaii	$193	+56%	Cigna	BCBS	89
7	South Dakota	$186	+50%	UHC	BCBS	39
8	North Dakota	$183	+47%	UHC	Aetna	34
9	Massachusetts	$177	+43%	UHC	BCBS	118
10	Minnesota	$168	+36%	UHC	Aetna	95
11	Georgia	$167	+35%	UHC	BCBS	114
12	Idaho	$153	+23%	UHC	BCBS	57
13	Washington	$151	+22%	UHC	Aetna	120
14	Colorado	$147	+18%	UHC	Aetna	104
15	Montana	$146	+18%	UHC	Cigna	36
16	Vermont	$145	+17%	UHC	Cigna	35
17	Maine	$144	+17%	UHC	BCBS	64
18	Connecticut	$141	+14%	UHC	Aetna	111
19	New Mexico	$134	+9%	UHC	BCBS	74
20	New Hampshire	$134	+8%	UHC	BCBS	56
21	Illinois	$130	+5%	UHC	Aetna	112
22	Oklahoma	$127	+3%	UHC	Aetna	112
23	Utah	$123	-1%	UHC	BCBS	116
24	New York	$121	-2%	UHC	Aetna	110
25	Mississippi	$121	-2%	UHC	Cigna	103
26	Arkansas	$120	-3%	UHC	BCBS	92
27	Kansas	$120	-3%	UHC	Aetna	106
28	Texas	$120	-4%	UHC	Aetna	123
29	Tennessee	$119	-4%	UHC	Cigna	120
30	California	$118	-4%	UHC	BCBS	122
31	Ohio	$115	-7%	UHC	BCBS	111
32	Kentucky	$114	-8%	UHC	BCBS	112
33	Missouri	$110	-11%	UHC	Aetna	110
33	Louisiana	$110	-11%	UHC	BCBS	109
35	West Virginia	$110	-11%	UHC	BCBS	78
36	Michigan	$109	-12%	UHC	BCBS	113
37	Nevada	$108	-13%	UHC	BCBS	112
38	Indiana	$107	-14%	UHC	Aetna	116
39	South Carolina	$107	-14%	UHC	BCBS	103
40	Rhode Island	$106	-14%	Aetna	BCBS	62
41	District of Columbia	$106	-14%	UHC	Aetna	52
42	Virginia	$104	-16%	UHC	Aetna	109
43	Delaware	$104	-16%	UHC	BCBS	47
44	Pennsylvania	$103	-17%	UHC	BCBS	116
45	New Jersey	$102	-18%	BCBS	Aetna	117
46	Alabama	$100	-19%	UHC	BCBS	113
47	Maryland	$99	-20%	UHC	BCBS	106
48	Florida	$94	-24%	UHC	Cigna	113
49	Arizona	$93	-25%	UHC	BCBS	110
50	North Carolina	$93	-25%	UHC	BCBS	118

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 92004?

In the files we analyzed, UnitedHealthcare, at a median of $168 across 3,834 sampled providers. Blue Cross Blue Shield is lowest at $106, 58% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 83% of the 2026 Medicare non-facility rate of $149.64.

Which state has the highest median for CPT 92004?

Alaska has the highest median at $330; North Carolina has the lowest at $93.

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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