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

To understand the potential cost of a medical procedure beforehand, it's crucial to utilize price transparency tools. You can often start by asking your provider for an estimated cost, but for more precise and comparable figures, you can use specialized tools. For specific procedure costs based on CPT codes and your location, you can use Payerprice's fee schedule lookup tool to research typical charges. Additionally, contact your insurance company to understand your specific benefits, deductibles, co-pays, and what portion of the cost they are likely to cover.

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

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are essential for standardizing billing and claims processing across the healthcare industry. When looking up healthcare costs, knowing the specific CPT code for your procedure allows you to search for the exact service and obtain more accurate price information. Tools like Payerprice's fee schedule lookup utilize CPT codes to provide granular pricing data for various locations.

Why do prices for the same medical service vary so much between different providers or facilities?

Healthcare prices can vary significantly due to several factors. These include differing negotiated rates between providers and insurance companies, the cost structure of different facilities (e.g., hospital vs. outpatient clinic), geographical location, the complexity of the service, provider reputation, and whether the provider is in-network or out-of-network for your insurance plan. Understanding these variations highlights the importance of using price transparency tools like Payerprice to compare costs before making a decision.

Will my insurance cover the entire cost of a medical procedure, or will I have out-of-pocket expenses?

It's rare for insurance to cover the entire cost of a medical procedure, as most plans involve some form of out-of-pocket expense. You will likely be responsible for costs such as deductibles (the amount you pay before your insurance starts to cover costs), co-pays (a fixed amount you pay for a service), and co-insurance (a percentage of the cost you pay after meeting your deductible). The exact amount depends on your specific insurance plan and whether the service is considered in-network or out-of-network. Always contact your insurance provider directly for a detailed breakdown of your benefits and potential out-of-pocket costs for a specific procedure.

How can I compare prices for healthcare services in my area?

Comparing healthcare prices requires using reliable resources. For a comprehensive comparison, you should first identify the specific CPT code for the service you need. Then, you can use price transparency tools designed to provide fee schedule information based on CPT codes and location. Payerprice offers a fee schedule lookup tool that allows you to search for specific CPT codes in your area, helping you compare costs across different providers and facilities. Additionally, you can inquire directly with providers for estimated costs and check with your insurance company for their contracted rates.

CPT 67228 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.

Treat Blood Vessels In The Eye, Laser Or Other Treatment To Destroy Abnormal Growths Of Blood Vessels On The Retina (Layer Of Tissue At The Back Of The Eye).

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Eye and Ocular Adnexa
Common Place of Service	11 - Office 24 - Ambulatory Surgical Center
Common Modifiers	None LT - Left side of body RT - Right side of body
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 67228
Medicaid Fee Schedule	View Medicaid rates for 67228

National average reimbursement for CPT 67228 by major payers:

$681.33

$772.49

$791.26

$811.26

Compare published rates across providers.

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CPT 67228

5 of 25 sample ratesHigher to lower in this preview

Memorial Hermann Surgery Center Katy LLP
TXAmbulatory Surgical Clinic/CenterNPI 1760412803Tax ID 20-3360737
$2,350.00Published rate
Lake Country Endoscopy Center, LLC
Lake Country Endoscopy Center LLC
WIAmbulatory Surgical Clinic/CenterNPI 1184897472Tax ID 26-1572986
$720.00Published rate
The Orthopaedic And Spine Center Of Southern Colorado, LLC
The Orthopaedic & Spine Center Of S Colorado
COAmbulatory Surgical Clinic/CenterNPI 1942540851Tax ID 46-1852637
$571.00Published rate
Acadiana Surgery Center, Inc.
Acadiana Surgery Center Inc
LAAmbulatory Surgical Clinic/CenterNPI 1871593269Tax ID 72-1235496
$410.00Published rate
Egnm LLC, Lewes Surgery Center
Egnm, LLC Dba Lewes Surgery Center
DEAmbulatory Surgical Clinic/CenterNPI 1275642480Tax ID 51-0411737
$200.00Published 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

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CPT 67228 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes

The CPT 67228 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 67228 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
67221-CPT	Moderate	Treat Abnormal Eye Tissue, Treatment In One Or More Sessions In One Or Both Eyes Of Abnormal Tissue Beneath The Retina. The Procedure May Include Stopping Or Stabilizing Leaking Fluid.
67227-CPT	Moderate	Treat Blood Vessels In The Eye, Laser Or Other Treatment To Destroy Abnormal Growths Of Blood Vessels On The Retina (Layer Of Tissue At The Back Of The Eye).
67228-CPT	Moderate	Treat Blood Vessels In The Eye, Laser Or Other Treatment To Destroy Abnormal Growths Of Blood Vessels On The Retina (Layer Of Tissue At The Back Of The Eye).
67229-CPT	High	Tr Retinal Les Preterm Inf, Treatment Of Extensive Or Progressive Retinopathy 1 Or More Sessions Preterm Infant Less Than 37 Weeks Gestation At Birth Performed From Birth Up To 1 Year Of Age Eg Retinopathy Of Prematurity Photocoagulation Or Cryotherapy

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67228. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 67228 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 67228 Fee Schedule

Memorial Hermann Surgery Center Katy LLP

Lake Country Endoscopy Center, LLC

The Orthopaedic And Spine Center Of Southern Colorado, LLC

Acadiana Surgery Center, Inc.

Egnm LLC, Lewes Surgery Center