Ophthalmology reimbursement
by service line
Compare commercial ophthalmology rates for cataract surgery, retinal treatment, diagnostic imaging, eye examinations, and office visits.
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 average published rate across billing entities for that payer.
National 66984 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Q2 2026 | 21,429 | $878.63 | ||||
| Cigna | Q2 2026 | 576 | $1,598.19 | ||||
| United | Q2 2026 | 29,152 | $864.95 |
- Source
- Negotiated rates 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.
How do specific ophthalmology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
Ophthalmology provider rates by payer
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|
Named provider examples are available in a scoped ophthalmology market comparison.
Choose one state to replace the mixed-state examples with payer-specific provider rates across all three preview codes.
No trial or data preparation required.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 | Nat'l avg | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|---|
$ per service · 2 codes | |||||
66821Laser treatment after cataract surgery | $471.08 | — | |||
66984Cataract removal with intraocular lens insertion | $878.63 | — | |||
$ per service · 1 code | |||||
67028Intravitreal injection of a drug | $166.98 | — | |||
$ per service · 8 codes | |||||
76514Corneal thickness measurement | $11.55 | — | |||
92020Gonioscopy | — | — | — | — | — |
92060Sensorimotor eye examination | $48.57 | — | |||
92083Extended visual field examination | $34.76 | — | |||
92133Optical coherence tomography of the optic nerve | $28.74 | — | |||
92134Optical coherence tomography of the retina | $31.51 | — | |||
92235Fluorescein angiography | $56.43 | — | |||
92250Fundus photography with interpretation | $27.91 | — | |||
$ per visit · 4 codes | |||||
92004Comprehensive eye examination, new patient | $151.56 | ||||
92012Intermediate eye examination, established patient | $85.42 | ||||
92014Comprehensive eye examination, established patient | $125.09 | ||||
92015Determination of refractive state | $27.51 | — | |||
$ per visit · 5 codes | |||||
99203New patient office visit, low complexity | $111.87 | — | |||
99204New patient office visit, moderate complexity | $172.94 | — | |||
99212Established patient office visit, straightforward complexity | $49.05 | — | |||
99213Established patient office visit, low complexity | $82.87 | — | |||
99214Established patient office visit, moderate complexity | $120.74 | — | |||
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 these ophthalmology rates are calculated
Use this methodology to understand what each published rate represents and which billing details must match before comparing ophthalmology services.
- Rate sourceEach value is a negotiated professional ophthalmology rate published in a payer machine-readable file, not a claim, charge, facility payment, or drug price.
- Rate calculationNational 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.
- Provider entityNamed examples use payer-file NPI and TIN records. An entity may represent a clinician, group practice, surgery center, health system, or another billing organization.
- Comparable ratesMatch 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.
Get the ophthalmology reimbursement data you're looking for
Choose the services, payers, states, networks, and provider entities relevant to your question. We'll confirm the available coverage and prepare the comparison.
- Tell us your marketShare the specialty, geography, payers, networks, and providers.
- We find comparable ratesPayerPrice aligns billing codes, services, settings, and units.
- Get your market viewSee relevant payer and provider rates organized around your question.
We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
Trusted by teams that need defensible reimbursement data
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?
The public table shows billing entities 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.