CPT 92250 · professional fee

Fundus photography w/i&r (CPT 92250): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 92250, from their published in-network rate files.

OphthalmologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$53

P10 to P90: $33 to $105

vs Medicare

142%

non-facility rate $37.07

Payer spread

1.45×

Cigna $60 vs Aetna $41

State spread

3.5×

AK $120 to FL $35

4,661 sampled providers6,339 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 92250 in the files analyzed, at $60, 45% above Aetna ($41), the lowest of the 4 payers shown.

The state spread is 3.5×: Alaska has the highest median at $120 and Florida the lowest at $35, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 142% of the Medicare non-facility rate ($37.07), which ranks 140th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Blue Cross Blue Shield (interquartile range $33) and widest within Cigna ($41).

This is a top-14 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	$60	$43	$84	+14%	1	3,770	162% of Medicare
UnitedHealthcare	$58	$46	$82	+9%	2	3,830	155% of Medicare
Blue Cross Blue Shield	$51	$38	$71	-2%	3	3,438	139% of Medicare
Aetna	$41	$35	$61	-21%	4	3,357	112% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($37.07)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$120	+129%	BCBS	Aetna	24
2	Iowa	$89	+69%	Cigna	Aetna	93
3	Oregon	$81	+54%	UHC	Aetna	100
4	South Dakota	$80	+53%	UHC	BCBS	39
5	Wisconsin	$80	+52%	BCBS	Aetna	104
6	Nebraska	$80	+52%	Cigna	Aetna	71
7	Connecticut	$77	+47%	UHC	BCBS	111
8	Massachusetts	$76	+44%	UHC	Cigna	118
9	North Dakota	$74	+41%	BCBS	Aetna	34
10	California	$72	+37%	Cigna	UHC	122
11	Georgia	$70	+33%	Cigna	Aetna	115
12	Minnesota	$64	+22%	BCBS	Aetna	95
13	Vermont	$64	+22%	BCBS	Cigna	35
14	Mississippi	$63	+20%	BCBS	Aetna	103
15	Colorado	$62	+17%	Cigna	Aetna	103
16	Washington	$62	+17%	Cigna	BCBS	119
17	New Hampshire	$61	+16%	UHC	BCBS	56
18	Arkansas	$60	+13%	Cigna	UHC	92
19	Michigan	$59	+13%	UHC	Aetna	112
20	Montana	$58	+11%	UHC	BCBS	36
21	Delaware	$58	+11%	Cigna	Aetna	47
22	Utah	$58	+10%	Cigna	BCBS	116
23	Idaho	$58	+9%	UHC	BCBS	57
24	North Carolina	$57	+9%	Cigna	Aetna	101
25	New Mexico	$54	+3%	Cigna	BCBS	74
26	Ohio	$54	+2%	BCBS	Aetna	110
27	Alabama	$53	+1%	Cigna	Aetna	111
28	Indiana	$52	-1%	BCBS	Aetna	116
29	Maine	$51	-3%	UHC	Aetna	63
30	Kentucky	$51	-3%	Cigna	Aetna	112
31	Illinois	$49	-7%	UHC	BCBS	112
32	Hawaii	$48	-8%	BCBS	Cigna	89
33	Missouri	$48	-9%	UHC	Aetna	110
34	South Carolina	$48	-9%	Cigna	Aetna	102
35	Tennessee	$47	-10%	BCBS	Cigna	120
36	Rhode Island	$47	-11%	Aetna	BCBS	62
37	Nevada	$47	-11%	Cigna	Aetna	112
38	District of Columbia	$46	-12%	Cigna	BCBS	51
38	Maryland	$46	-12%	UHC	BCBS	106
40	Kansas	$45	-14%	Cigna	Aetna	106
41	West Virginia	$45	-15%	UHC	Aetna	77
42	Virginia	$45	-15%	UHC	Cigna	109
43	New Jersey	$44	-16%	Aetna	Cigna	117
44	Louisiana	$44	-16%	Aetna	Cigna	109
45	New York	$44	-17%	Aetna	BCBS	110
46	Pennsylvania	$42	-21%	UHC	Aetna	117
47	Oklahoma	$41	-22%	UHC	Aetna	112
48	Arizona	$37	-30%	UHC	Aetna	109
49	Texas	$35	-34%	UHC	BCBS	123
50	Florida	$35	-34%	UHC	Aetna	112

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 92250?

In the files we analyzed, Cigna, at a median of $60 across 3,770 sampled providers. Aetna is lowest at $41, 45% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 142% of the 2026 Medicare non-facility rate of $37.07.

Which state has the highest median for CPT 92250?

Alaska has the highest median at $120; 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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