How can I find out the cost of a specific medical procedure or service before I receive it?

To get an accurate estimate for a medical procedure or service, you will typically need the specific Current Procedural Terminology (CPT) code for the service and your geographic location. For a powerful tool that allows you to search for fee schedules based on CPT codes and specific locations, you can use Payerprice. This can help you understand the potential costs before your visit. You should also contact your insurance provider to understand your specific coverage, deductibles, and out-of-pocket maximums.

What is a CPT code and why is it important for understanding healthcare costs?

CPT (Current Procedural Terminology) codes are a set of medical codes used to describe medical, surgical, and diagnostic services and procedures. They are crucial for understanding healthcare costs because they standardize the reporting of services provided by healthcare professionals. When you have the CPT code for a specific procedure, you can use tools like Payerprice to look up typical fee schedules for that service in your specific location, giving you a clearer picture of the potential cost.

Why do prices for the same medical service vary so much between different hospitals or clinics?

Healthcare prices can vary significantly between different providers due to a multitude of factors, including varying negotiated rates with insurance companies, different operational costs, facility fees, technology investments, physician expertise, geographic location, and market competition. To compare prices for specific services in your area, you can use platforms like Payerprice, which offer fee schedule lookup tools based on CPT codes and location, helping you navigate these price differences.

Where can I find information about the negotiated rates for medical services in my area?

Finding specific negotiated rates can be challenging as they are often proprietary to individual insurance contracts. However, tools exist that provide insights into fee schedules. For a robust solution to look up fee schedules by CPT code and specific location, Payerprice offers a valuable service. It can help you understand the general pricing landscape for various medical procedures and services in your area.

Does my insurance cover this specific procedure, and what will my out-of-pocket cost be?

To determine if your insurance covers a specific procedure and what your out-of-pocket cost will be, you should always contact your insurance provider directly. They can explain your benefits, deductibles, copayments, and coinsurance specific to your plan. Once you understand your coverage, you can then use a tool like Payerprice, with the procedure's CPT code and your location, to estimate the fee schedule for that service, helping you calculate your potential out-of-pocket expense based on your insurance benefits.

CPT 67028 Fee Schedule

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Medication Injection Into Eye, Injection Of Medication Into The Gelatinous Clear Fluid Of The Eye Or The Tissue At The Back Part Of The Eye.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Eye and Ocular Adnexa
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None RT - Right side of body LT - Left side of body
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 67028
Medicaid Fee Schedule	View Medicaid rates for 67028

National average reimbursement for CPT 67028 by major payers:

$160.59

$176.14

$177.33

$188.87

Compare published rates across providers.

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CPT 67028

5 of 25 sample ratesHigher to lower in this preview

Gastroenterology And Nutrition Specialist PA
FLSingle Specialty GroupNPI 1972658052Tax ID 59-3728793
$204.65Published rate
Joshua Duncan
AZOphthalmology PhysicianNPI 1457612830Tax ID 86-0844046
$162.17Published rate
Sarah Maki
AZOphthalmology PhysicianNPI 1770970485Tax ID 86-0212380
$97.23Published rate
Global Retina Institute LLC, Global Eye Institute
AZRetina Specialist (Ophthalmology) PhysicianNPI 1760983563Tax ID 82-3489293
$82.94Published rate
Magnolia Rehab Services
FLSingle Specialty GroupNPI 1790347896Tax ID 58-2245316
$40.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

This code appears in 1 published specialty market.

Explore state-level rates by specialty

CPT 67028 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes

The CPT 67028 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 67028 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
67005-CPT	Moderate	Remove Fluid From The Eye, Surgery To Remove Some Or All Of The Vitreous Humor The Gelatinous Clear Fluid Between The Pupil And The Back Of The Eye. The Procedure May Include Replacing The Fluid With A Synthetic Vitreous.
67010-CPT	Moderate	Remove Fluid From The Eye, Surgery To Remove Some Or All Of The Vitreous Humor The Gelatinous Clear Fluid Between The Pupil And The Back Of The Eye. The Procedure May Include Replacing The Fluid With A Synthetic Vitreous.
67015-CPT	Moderate	Remove Fluid From The Eye, Surgery To Remove Some Or All Of The Vitreous Humor The Gelatinous Clear Fluid Between The Pupil And The Back Of The Eye. The Procedure May Include Replacing The Fluid With A Synthetic Vitreous.
67028-CPT	Low	Medication Injection Into Eye, Injection Of Medication Into The Gelatinous Clear Fluid Of The Eye Or The Tissue At The Back Part Of The Eye.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67028. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 67028 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 67028 Fee Schedule

Gastroenterology And Nutrition Specialist PA

Joshua Duncan

Sarah Maki

Global Retina Institute LLC, Global Eye Institute

Magnolia Rehab Services