Ophthalmology reimbursement rates by service line
Compare national ophthalmology reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 66984, 67028 and 92134 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.
Rate Explorer
Compare national ophthalmology rates by payer
Compare payer benchmarks for cataract surgery, retinal treatment, and retinal imaging, then review the diagnostic and visit services that complete the market.
Aetna state variation for 66984
National 66984 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 66984 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 33,450 | $727.69 | $788.16 | |||
| Cigna | Jun–Jul 2026 | 27,626 | $747.96 | $906.11 | |||
| United | Jun–Jul 2026 | 29,152 | $718.14 | $864.95 | |||
| Anthem | Jun–Jul 2026 | 26,072 | $1,054.52 | $1,302.09 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for cataract surgery with intraocular lens (66984).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
Confirm coverage for your codes, payers and markets.
How do specific ophthalmology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Ophthalmology provider rates by payer (CPT 66984)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| G BROCK MAGRUDER MD PA DBA MAGRUDER EYE INSTITUTENPI 1003818261 · Tax ID 593347759 | FL | 67 | $404.66 | -$323.03 | Below P25 |
| CLEAR VISION OPHTHALMOLOGY PCNPI 1538176243 · Tax ID 201585825 | AZ | 8 | $563.38 | -$164.32 | Below P25 |
| EYE CARE AND LASER SURGERY OF NEWTONWELLESLEYNPI 1275629230 · Tax ID 260215761 | MA | 8 | $640.28 | -$87.42 | P25 to median |
| NEW JERSEY EYE CENTERNPI 1104870427 · Tax ID 221967242 | NJ | 40 | $704.26 | -$23.43 | P25 to median |
| RICHARD CASEY MD MEDICAL CORPORATIONNPI 1609890797 · Tax ID 271407374 | CA | 2 | Median to P75 | ||
| BARBARA J ARNOLD MD INCNPI 1043214075 · Tax ID 680078903 | CA | 2 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates for available preview codes.
No trial or data preparation required.Which providers have the highest claim volume in the ophthalmology market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the ophthalmology market.
- 1CARetina Institute of California Medical GroupNPI 1760541569Medicare 102,676Medicaid 14,990117,666 total
- 2MNVitreoretinal Surgery PLLCNPI 1891783965Medicare 107,312Medicaid 1,395108,707 total
- 3MULTIBarnet Dulaney Perkins Eye CenterNPI 1376574707Medicare 62,970Medicaid 24,74587,715 total
- 4OHRetina Associates Of Cleveland INCNPI 1912991225Medicare 81,779Medicaid 3,69485,473 total
- 5NJEye Centers of America LLCNPI 1649563636Medicare 84,087Medicaid 084,087 total
- 6TXHouston Eye AssociatesNPI 1467420240Medicare 76,456Medicaid 2,92479,380 total
- 7MULTICei Physicians Psc LLCNPI 1942296298Medicare 36,618Medicaid 17,73554,353 total
- 8MULTIAssociated Retinal Consultants LLCNPI 1164578894Medicare 52,111Medicaid 052,111 total
- 9CACalifornia Retina Associates LPNPI 1114033404Medicare 32,468Medicaid 16,49548,963 total
- 10MULTIRegents Of The University Of MichiganNPI 1568495299Medicare 43,860Medicaid 3,44047,300 total
- 11MULTIEye Health Northwest PCNPI 1619959731Medicare 46,131Medicaid 10146,232 total
- 12MILansing Ophthalmology PCNPI 1962485342Medicare 43,106Medicaid 74943,855 total
- 13FLCenter For Excellence In Eyecare PANPI 1043227176Medicare 42,068Medicaid 1442,082 total
- 14NYSajid Malik MD PCNPI 1215161047Medicare 34,344Medicaid 7,14541,489 total
- 15OHPediatric Ophthalmology Associates INCNPI 1831257161Medicare 35,075Medicaid 4,78339,858 total
- 16MULTIOmni Eye SpecialistsNPI 1376593863Medicare 37,634Medicaid 43938,073 total
- 17CADe La Pena Eye Clinic Amg INCNPI 1114931052Medicare 32,470Medicaid 3,59336,063 total
- 18MULTISouthwestern Eye Center LtdNPI 1023063187Medicare 22,722Medicaid 11,95134,673 total
- 19MULTICarolina Eye Associates INCNPI 1245211333Medicare 30,301Medicaid 3,06133,362 total
- 20VADavid M Harman MD LLCNPI 1306950431Medicare 31,321Medicaid 92932,250 total
How reimbursement changes across ophthalmology services
Keep procedures, injections, drugs, imaging and testing, eye examinations, and office visits in their appropriate billing context.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 2 codes | ||||
66821Laser treatment after cataract surgery | $427.86 | $478.41 | $501.78 | $633.89 |
66984Cataract removal with intraocular lens insertion | $788.16 | $906.11 | $864.95 | $1,302.09 |
$ per service · 1 code | ||||
67028Intravitreal injection of a drug | $146.84 | $181.06 | $176.92 | $267.62 |
$ per service · 8 codes | ||||
76514Corneal thickness measurement | $9.85 | $11.86 | $11.28 | $17.07 |
92020Gonioscopy | $27.15 | Not available | Not available | Not available |
92060Sensorimotor eye examination | $43.22 | $53.36 | $50.24 | $70.47 |
92083Extended visual field examination | $31.20 | $38.94 | $36.60 | $52.44 |
92133Optical coherence tomography of the optic nerve | $26.25 | $31.99 | $31.43 | $46.04 |
92134Optical coherence tomography of the retina | $28.79 | $35.05 | $34.97 | $49.75 |
92235Fluorescein angiography | $50.45 | $62.38 | $57.95 | $82.93 |
92250Fundus photography with interpretation | $25.27 | $31.29 | $29.25 | $42.47 |
$ per visit · 4 codes | ||||
92004Comprehensive eye examination, new patient | $135.49 | $169.51 | $194.42 | $188.20 |
92012Intermediate eye examination, established patient | $76.60 | $98.56 | $114.02 | $117.14 |
92014Comprehensive eye examination, established patient | $111.45 | $139.64 | $162.29 | $159.34 |
92015Determination of refractive state | $24.21 | $31.44 | $30.01 | $40 |
$ per visit · 5 codes | ||||
99203New patient office visit, low complexity | $101.40 | $132.39 | $144.04 | $171.34 |
99204New patient office visit, moderate complexity | $157.41 | $205.58 | $218.38 | $261.18 |
99212Established patient office visit, straightforward complexity | $44.38 | $58.10 | $62.51 | $73.82 |
99213Established patient office visit, low complexity | $74.91 | $98.21 | $101.66 | $121.86 |
99214Established patient office visit, moderate complexity | $109.16 | $142.83 | $146.85 | $173.04 |
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How to read these ophthalmology rates
Benchmarks calculated by PayerPrice from health plan price transparency files. CMS price transparency requirements.
- Published rates, not paymentsThese figures summarize negotiated rates reported by health plans. They are not claim payments, patient prices or a provider's verified contract.
- Average vs. medianThe average combines eligible billing-entity rates; the median is the middle rate. A large gap between them can signal that high or low rates are pulling the average.
- What a provider row meansA billing entity may be a clinician, practice, facility or health system. A named row does not always represent one individual provider.
- Compare like for likeMatch the code, billing component, setting, payment unit, network and reporting period. Facility, drug and other service payments may be separate.
Calculation details and specialty-specific notes
Use this methodology to understand what each published rate represents and which billing details must match before comparing ophthalmology services.
- Rate source
- Each value is a negotiated professional ophthalmology rate published in a payer machine-readable file, not a claim, charge, facility payment, or drug price.
- Rate calculation
- National figures use eligible published rate records across the country; state views use records tied to the selected state. Averages are not weighted by procedure or patient volume. The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities. Tied boundary values stay together, so fewer rates may be removed. A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming. A missing benchmark does not mean the rate is zero.
- Provider entity
- Named examples use payer-file NPI and TIN records. An entity may represent a clinician, group practice, surgery center, health system, or another billing organization. Each NPI and TIN combination contributes one representative rate: its most frequent normalized value. When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Match the exact code, modifier or billing component, site of service, payment unit, payer product, and network. Drug and facility payments may be separate from the professional procedure. Benchmarks keep the payer, service code, geography, reporting period and billing unit separate. Different services or payment units are not blended into one rate.
Compare Ophthalmology rates in your market
Tell us the services, payers and locations you need. We'll confirm coverage and scope the comparison.
- Define the scopeChoose the codes, payers, networks and providers.
- Match the billing detailsWe align services, settings and payment units.
- Compare the ratesReview payer and provider rates for your selected market.
We'll explain what's available, flag gaps and help define the comparison.
Trusted by teams that need defensible reimbursement data
Explore ophthalmology rates by state
Choose a state to compare payer reference averages for common services.
How to interpret ophthalmology rates
How to interpret the selected market and payer-published rates.
Which ophthalmology services are represented?
The report includes cataract and laser procedures, retinal injections and imaging, eye examinations, visual field testing, and office visits.
Does an injection code include the drug?
Not necessarily. The professional procedure and the administered drug may be billed separately and should be evaluated independently.
How should diagnostic imaging rates be compared?
Compare the same imaging code and confirm whether the published amount represents the professional, technical, or global service.
Which billing details change an ophthalmology rate comparison?
Confirm the exact code, modifier or billing component, site of service, whether the rate is for a procedure or drug, payer product, and network.
How are named ophthalmology providers selected?
Provider examples are sampled from different points in the selected payer's rate range. An entity may be a clinician, group practice, ambulatory surgery center, health system, or another billing organization. The national overview includes public provider samples; state provider-level comparisons require a free state preview.