Ophthalmology · Illinois
Ophthalmology commercial reimbursement in Illinois
How Illinois ophthalmology rates compare with the national market.
Ophthalmology in Illinois
42 codes · 112 sampled providers
Index vs national
99
1% below
Rank among states
24 of 50
1 = highest
Codes above national
21 of 42
median code at 100%
Providers
112
sampled
What the data shows
1
Ophthalmology ranks 24th of 50 states in Illinois with an index of 99 (100 = the specialty's national median), across 42 codes and 112 sampled providers.
2
Of the 42 ophthalmology codes with enough data in Illinois, 21 pay above the national median and 21 below; the typical code sits at 100% of the national median.
3
Largest premium over the national median: CPT 65820 (Goniotomy) at 122%; largest discount: CPT 65778 (Cover eye w/membrane) at 88%.
4
Measured against Medicare, Illinois ophthalmology rates have a median of 121% of the Medicare rate across these codes.
Codes above and below the national median
The five largest gaps in each direction
Highest vs national
All ophthalmology codes in Illinois
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Illinois | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 65820 Goniotomy | $1,164 | $955 | +22% | 161% | 111 | 281 | |
| CPT 93000 Electrocardiogram complete | $25 | $21 | +21% | 165% | 105 | 142 | |
| CPT 66984 Xcapsl ctrc rmvl w/o ecp | $892 | $738 | +21% | 193% | 111 | 284 | |
| CPT 66991 Xcapsl ctrc rmvl insj 1+ | $997 | $840 | +19% | 171% | 111 | 278 | |
| CPT 66821 After cataract laser surgery | $463 | $393 | +18% | 138% | 111 | 284 | |
| CPT 67036 Removal of inner eye fluid | $1,296 | $1,117 | +16% | 171% | 111 | 281 | |
| CPT 65756 Corneal trnspl endothelial | $1,634 | $1,425 | +15% | 165% | 112 | 279 | |
| CPT 67210 Treatment of retinal lesion | $733 | $659 | +11% | 142% | 111 | 282 | |
| CPT 66982 Xcapsl ctrc rmvl cplx wo ecp | $1,084 | $981 | +10% | 172% | 111 | 283 | |
| CPT 67042 Vit for macular hole | $1,645 | $1,494 | +10% | 172% | 111 | 279 | |
| CPT 67108 Repair detached retina | $1,711 | $1,594 | +7% | 172% | 111 | 281 | |
| CPT 67904 Repair eyelid defect | $874 | $816 | +7% | 117% | 111 | 278 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $74 | $69 | +7% | 107% | 105 | 142 | |
| CPT 15823 Blepharp upr eyelid xcsv skn | $718 | $677 | +6% | 114% | 111 | 278 | |
| CPT 68761 Close tear duct opening | $174 | $164 | +6% | 121% | 111 | 282 | |
| CPT 92004 Compre oph exam new pt 1/> | $130 | $124 | +5% | 87% | 112 | 289 | |
| CPT 92020 Gonioscopy | $27 | $26 | +3% | 102% | 111 | 284 | |
| CPT 92014 Compre oph exam est pt 1/> | $104 | $101 | +3% | 167% | 112 | 289 | |
| CPT 92201 Opscpy extnd rta draw uni/bi | $27 | $27 | +2% | 108% | 111 | 281 | |
| CPT 92202 Opscpy extnd on/mac draw | $17 | $17 | +1% | 109% | 111 | 281 | |
| CPT 99215 Office o/p est hi 40 min | $149 | $148 | +0% | 77% | 111 | 285 | |
| CPT 92083 Extended visual field xm | $72 | $73 | -1% | 113% | 111 | 283 | |
| CPT 67028 Injection eye drug | $135 | $137 | -1% | 118% | 111 | 285 | |
| CPT 99213 Office o/p est low 20 min | $72 | $73 | -2% | 75% | 111 | 287 | |
| CPT 92273 Full field erg w/i&r | $139 | $142 | -2% | 113% | 111 | 279 | |
| CPT 67840 Remove eyelid lesion | $248 | $253 | -2% | 185% | 111 | 281 | |
| CPT 99205 Office o/p new hi 60 min | $201 | $205 | -2% | 85% | 111 | 285 | |
| CPT 92134 Cptrz oph dx img pst sgm rta | $44 | $45 | -2% | 134% | 111 | 282 | |
| CPT 99204 Office o/p new mod 45 min | $154 | $158 | -2% | 87% | 111 | 287 | |
| CPT 99203 Office o/p new low 30 min | $99 | $101 | -3% | 84% | 111 | 287 | |
| CPT 99214 Office o/p est mod 30 min | $104 | $107 | -3% | 77% | 111 | 287 | |
| CPT 76512 Oph us dx b-scan | $68 | $70 | -3% | 139% | 111 | 283 | |
| CPT 65855 Trabeculoplasty laser surg | $295 | $307 | -4% | 120% | 111 | 281 | |
| CPT 99212 Office o/p est sf 10 min | $41 | $43 | -4% | 69% | 111 | 285 | |
| CPT 92133 Cptrzd oph dx img pst sgm on | $40 | $42 | -6% | 130% | 111 | 282 | |
| CPT 92250 Fundus photography w/i&r | $49 | $53 | -7% | 131% | 112 | 284 | |
| CPT 92025 Cptrized corneal topography | $37 | $40 | -7% | 100% | 111 | 281 | |
| CPT 92136 Ophthalmic biometry | $63 | $69 | -8% | 132% | 111 | 282 | |
| CPT 92012 Intrm oph exam est patient | $69 | $76 | -9% | 167% | 112 | 289 | |
| CPT 92235 Fluorescein angrph mltiframe | $132 | $145 | -9% | 81% | 111 | 281 | |
| CPT 92242 Fluorescein&icg angiography | $254 | $288 | -12% | 75% | 111 | 277 | |
| CPT 65778 Cover eye w/membrane | $62 | $70 | -12% | 172% | 111 | 280 |
Frequently asked questions
How do Illinois ophthalmology rates compare with the rest of the country?
Illinois ranks 24th of 50 states with an index of 99; 21 of 42 codes are above the national median.
Which ophthalmology code has the biggest premium in Illinois?
CPT 65820 (Goniotomy), at 122% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
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.
Benchmark your Illinois ophthalmology contracts
Compare your rates with these medians.