Ophthalmology · specialty benchmark

Ophthalmology commercial reimbursement benchmarks

What commercial payers pay for the procedures that matter most to ophthalmology practices.

Ophthalmology at a glance

4,698 sampled providers

Codes tracked

publishable codes

Median % of Medicare

117%

across codes

Highest state

Alaska

Highest payer

UHC

UnitedHealthcare

Ophthalmology rates in this dataset cover 42 procedure codes and 4,698 sampled providers in 51 states, at a median 117% of Medicare.

Alaska has the highest ophthalmology index and Florida the lowest.

UnitedHealthcare has the highest ophthalmology index and Aetna the lowest.

The biggest revenue code by Medicare allowed dollars is CPT 92014 (Compre oph exam est pt 1/>), paid at a 101-dollar median, 162% of Medicare.

Ranked by Medicare allowed dollars billed by the specialty

Rank	Code	Median	Medicare	% of Medicare	Providers
1	CPT 92014 Compre oph exam est pt 1/>	$101	$62.13	162%	4,687
2	CPT 66984 Xcapsl ctrc rmvl w/o ecp	$738	$462.60	159%	4,657
3	CPT 67028 Injection eye drug	$137	$114.23	120%	4,666
4	CPT 99214 Office o/p est mod 30 min	$107	$135.61	79%	4,682
5	CPT 92134 Cptrz oph dx img pst sgm rta	$45	$32.73	137%	4,654
6	CPT 99213 Office o/p est low 20 min	$73	$95.19	76%	4,682
7	CPT 92012 Intrm oph exam est patient	$76	$41.42	182%	4,687
8	CPT 66821 After cataract laser surgery	$393	$335.35	117%	4,675
9	CPT 99204 Office o/p new mod 45 min	$158	$177.36	89%	4,682
10	CPT 92083 Extended visual field xm	$73	$63.80	114%	4,663

Index: 100 = four-payer median for the specialty's codes

Payer	Index	Rank	Highest on
UnitedHealthcare	107	1	55%
Blue Cross Blue Shield	105	2	36%
Cigna	100	3	10%
Aetna	88	4	0%

Index: 100 = the specialty's national median

Rank	State	Index	Codes	Providers
1	Alaska	259	42	24
2	Nebraska	168	42	71
3	Oregon	164	42	100
4	Wisconsin	164	42	104
5	South Dakota	153	42	39
6	North Dakota	149	42	34
7	Iowa	147	42	93
8	Massachusetts	135	42	118
9	Georgia	132	42	115
10	Minnesota	129	42	95
11	Connecticut	126	42	111
12	Montana	125	42	36
13	Idaho	125	42	57
14	Washington	122	42	120
15	Vermont	117	42	38
16	Colorado	116	42	104
17	Hawaii	115	42	89
18	Maine	113	42	64
19	New Hampshire	111	42	56
20	New Mexico	110	42	74
21	Mississippi	110	42	103
22	Michigan	102	42	113
23	Utah	102	42	116
24	Illinois	99	42	112
25	Rhode Island	98	42	62
26	North Carolina	98	42	119
27	Kansas	96	42	106
28	California	96	42	122
29	Arkansas	94	42	92
30	Alabama	94	42	113
31	Ohio	93	42	111
32	Tennessee	93	42	121
33	Indiana	93	42	116
34	New York	92	42	110
35	West Virginia	91	42	78
36	Missouri	90	42	110
37	Nevada	88	42	113
38	Kentucky	88	42	112
39	Louisiana	88	42	110
40	South Carolina	87	42	104
41	District of Columbia	87	42	52
42	Virginia	86	42	109
43	Texas	86	42	123
44	Oklahoma	85	42	112
45	Maryland	85	42	106
46	New Jersey	85	42	117
47	Pennsylvania	84	42	117
48	Delaware	82	42	47
49	Arizona	79	42	110
50	Florida	68	42	113

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 negotiated rates compare by code, payer and state.