Ophthalmology · Maryland

Ophthalmology commercial reimbursement in Maryland

How Maryland ophthalmology rates compare with the national market.

Ophthalmology in Maryland

42 codes · 106 sampled providers
Index vs national
85
15% below
Rank among states
45 of 50
1 = highest
Codes above national
1 of 42
median code at 85%
Providers
106
sampled

What the data shows

1

Ophthalmology ranks 45th of 50 states in Maryland with an index of 85 (100 = the specialty's national median), across 42 codes and 106 sampled providers.

2

Of the 42 ophthalmology codes with enough data in Maryland, 1 pay above the national median and 41 below; the typical code sits at 85% of the national median.

3

Largest premium over the national median: CPT 92235 (Fluorescein angrph mltiframe) at 100%; largest discount: CPT 76512 (Oph us dx b-scan) at 67%.

4

Measured against Medicare, Maryland ophthalmology rates have a median of 101% of the Medicare rate across these codes.

Codes above and below the national median

The five largest gaps in each direction

Highest vs national

CodeMarylandNationalGapProv.
92235
Fluorescein angrph mltiframe
$145$145+0%106
92025
Cptrized corneal topography
$37$40-6%106
92242
Fluorescein&icg angiography
$268$288-7%105
92134
Cptrz oph dx img pst sgm rta
$41$45-9%106
92133
Cptrzd oph dx img pst sgm on
$38$42-10%106

Lowest vs national

CodeMarylandNationalGapProv.
76512
Oph us dx b-scan
$47$70-33%105
20610
Drain/inj joint/bursa w/o us
$50$69-27%102
93000
Electrocardiogram complete
$16$21-23%103
99213
Office o/p est low 20 min
$57$73-22%106
99214
Office o/p est mod 30 min
$84$107-22%106

All ophthalmology codes in Maryland

Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
CodeMarylandNationalGap% of MedicareProvidersTINsLevel
CPT 92235
Fluorescein angrph mltiframe
$145$145+0%89%106192
CPT 92025
Cptrized corneal topography
$37$40-7%101%106196
CPT 92242
Fluorescein&icg angiography
$268$288-7%80%105189
CPT 92134
Cptrz oph dx img pst sgm rta
$41$45-9%124%106196
CPT 92133
Cptrzd oph dx img pst sgm on
$38$42-10%124%106195
CPT 65756
Corneal trnspl endothelial
$1,284$1,425-10%129%105192
CPT 67210
Treatment of retinal lesion
$587$659-11%113%105193
CPT 65778
Cover eye w/membrane
$62$70-11%173%106194
CPT 67108
Repair detached retina
$1,409$1,594-12%142%105193
CPT 92250
Fundus photography w/i&r
$46$53-12%125%106194
CPT 92083
Extended visual field xm
$64$73-12%101%106195
CPT 66984
Xcapsl ctrc rmvl w/o ecp
$647$738-12%140%106196
CPT 67036
Removal of inner eye fluid
$975$1,117-13%128%105193
CPT 67042
Vit for macular hole
$1,299$1,494-13%136%105193
CPT 66982
Xcapsl ctrc rmvl cplx wo ecp
$847$981-14%134%105193
CPT 92201
Opscpy extnd rta draw uni/bi
$23$27-14%91%106195
CPT 15823
Blepharp upr eyelid xcsv skn
$582$677-14%92%105193
CPT 92202
Opscpy extnd on/mac draw
$14$17-14%92%106195
CPT 67904
Repair eyelid defect
$699$816-14%94%105192
CPT 92136
Ophthalmic biometry
$59$69-15%122%106196
CPT 66991
Xcapsl ctrc rmvl insj 1+
$717$840-15%123%105193
CPT 68761
Close tear duct opening
$140$164-15%98%106196
CPT 66821
After cataract laser surgery
$335$393-15%100%106196
CPT 92020
Gonioscopy
$22$26-15%84%106197
CPT 65820
Goniotomy
$806$955-16%111%105193
CPT 65855
Trabeculoplasty laser surg
$258$307-16%105%105193
CPT 67028
Injection eye drug
$114$137-16%100%106193
CPT 99215
Office o/p est hi 40 min
$124$148-17%64%106197
CPT 92273
Full field erg w/i&r
$117$142-17%95%105191
CPT 99212
Office o/p est sf 10 min
$35$43-19%58%106202
CPT 92014
Compre oph exam est pt 1/>
$81$101-19%131%106199
CPT 99205
Office o/p new hi 60 min
$165$205-20%70%106202
CPT 92012
Intrm oph exam est patient
$60$76-20%145%106200
CPT 99203
Office o/p new low 30 min
$81$101-20%69%106202
CPT 92004
Compre oph exam new pt 1/>
$99$124-20%66%106199
CPT 99204
Office o/p new mod 45 min
$125$158-20%71%106197
CPT 67840
Remove eyelid lesion
$200$253-21%149%105193
CPT 99214
Office o/p est mod 30 min
$84$107-22%62%106197
CPT 99213
Office o/p est low 20 min
$57$73-22%60%106198
CPT 93000
Electrocardiogram complete
$16$21-23%105%103190
CPT 20610
Drain/inj joint/bursa w/o us
$50$69-27%73%102191
CPT 76512
Oph us dx b-scan
$47$70-33%96%105190

Frequently asked questions

How do Maryland ophthalmology rates compare with the rest of the country?

Maryland ranks 45th of 50 states with an index of 85; 1 of 42 codes are above the national median.

Which ophthalmology code has the biggest premium in Maryland?

CPT 92235 (Fluorescein angrph mltiframe), at 100% 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.

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