CPT 92012 · professional fee

Intrm oph exam est patient (CPT 92012): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 92012, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$76

P10 to P90: $46 to $141

vs Medicare

182%

facility rate $41.42

Payer spread

1.76×

UHC $97 vs Aetna $55

State spread

3.7×

AK $196 to AL $53

4,687 sampled providers6,948 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 92012 in the files analyzed, at $97, 76% above Aetna ($55), the lowest of the 4 payers shown.

The state spread is 3.7×: Alaska has the highest median at $196 and Alabama the lowest at $53, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 182% of the Medicare facility rate ($41.42), which ranks 62nd of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Blue Cross Blue Shield (interquartile range $24) and widest within Cigna ($48).

This is a top-7 code for ophthalmology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($90.52) is 2.2× higher because it includes device or supply cost that professional-fee contracts do not.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$97	$78	$134	+29%	1	3,824	235% of Medicare
Blue Cross Blue Shield	$80	$61	$85	+6%	2	3,845	193% of Medicare
Cigna	$63	$49	$98	-16%	3	3,761	153% of Medicare
Aetna	$55	$47	$67	-27%	4	3,367	133% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($41.42)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$196	+159%	n/a	n/a	24
2	Oregon	$117	+54%	UHC	Aetna	99
3	Hawaii	$116	+54%	Cigna	BCBS	89
4	Wisconsin	$115	+52%	UHC	Aetna	104
5	Iowa	$112	+48%	UHC	Aetna	93
6	North Dakota	$107	+41%	UHC	Aetna	34
7	Nebraska	$105	+39%	UHC	Aetna	71
8	South Dakota	$103	+37%	UHC	BCBS	39
9	Massachusetts	$102	+35%	UHC	Aetna	118
10	Georgia	$94	+25%	UHC	BCBS	114
11	Minnesota	$91	+21%	UHC	Aetna	95
12	Washington	$90	+19%	UHC	Cigna	120
13	Vermont	$87	+16%	UHC	Cigna	35
14	Idaho	$83	+9%	UHC	Cigna	57
15	Maine	$81	+8%	UHC	Aetna	64
16	Mississippi	$80	+6%	UHC	Cigna	103
16	Colorado	$80	+6%	UHC	Aetna	104
18	New Hampshire	$79	+5%	UHC	Aetna	56
19	Connecticut	$78	+4%	UHC	Aetna	111
20	Montana	$78	+3%	UHC	Cigna	36
21	New Mexico	$76	-0%	UHC	Cigna	74
22	New York	$75	-1%	UHC	Aetna	110
23	Arkansas	$72	-4%	UHC	Cigna	92
24	Tennessee	$72	-5%	UHC	Cigna	120
25	Ohio	$72	-5%	UHC	Aetna	111
26	Illinois	$69	-9%	UHC	Aetna	112
27	Nevada	$69	-9%	UHC	Aetna	112
28	Kansas	$69	-9%	UHC	Aetna	106
29	Texas	$68	-10%	UHC	Aetna	123
30	Kentucky	$68	-10%	UHC	Aetna	112
31	Oklahoma	$68	-10%	UHC	Aetna	112
32	Utah	$67	-11%	UHC	Aetna	116
33	Louisiana	$67	-11%	UHC	Cigna	109
34	Pennsylvania	$67	-12%	UHC	Aetna	116
35	California	$66	-12%	UHC	Cigna	122
36	Delaware	$64	-15%	BCBS	Aetna	47
37	New Jersey	$64	-15%	BCBS	Aetna	117
38	Virginia	$63	-16%	UHC	Cigna	109
39	Rhode Island	$63	-17%	Aetna	UHC	62
40	West Virginia	$63	-17%	UHC	Cigna	78
41	Missouri	$63	-17%	UHC	Aetna	110
42	Michigan	$62	-18%	UHC	BCBS	113
43	Arizona	$61	-19%	UHC	Aetna	110
44	North Carolina	$61	-19%	UHC	Aetna	118
45	Florida	$61	-19%	BCBS	Cigna	113
46	South Carolina	$61	-19%	UHC	Cigna	103
47	Maryland	$60	-20%	UHC	BCBS	106
48	District of Columbia	$56	-25%	UHC	BCBS	52
49	Indiana	$55	-27%	UHC	Aetna	116
50	Alabama	$53	-29%	UHC	Cigna	113

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 92012?

In the files we analyzed, UnitedHealthcare, at a median of $97 across 3,824 sampled providers. Aetna is lowest at $55, 76% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 182% of the 2026 Medicare facility rate of $41.42.

Which state has the highest median for CPT 92012?

Alaska has the highest median at $196; Alabama has the lowest at $53.

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.

See how your contracts compare for CPT 92012

Benchmark your negotiated rates for 92012 and the rest of your book against these payer and state medians.

Request a rate benchmark