Ophthalmology · Pennsylvania
Ophthalmology commercial reimbursement in Pennsylvania
How Pennsylvania ophthalmology rates compare with the national market.
Ophthalmology in Pennsylvania
42 codes · 117 sampled providers
Index vs national
84
16% below
Rank among states
47 of 50
1 = highest
Codes above national
0 of 42
median code at 85%
Providers
117
sampled
What the data shows
1
Ophthalmology ranks 47th of 50 states in Pennsylvania with an index of 84 (100 = the specialty's national median), across 42 codes and 117 sampled providers.
2
Of the 42 ophthalmology codes with enough data in Pennsylvania, 0 pay above the national median and 42 below; the typical code sits at 85% of the national median.
3
Largest premium over the national median: CPT 99212 (Office o/p est sf 10 min) at 95%; largest discount: CPT 76512 (Oph us dx b-scan) at 73%.
4
Measured against Medicare, Pennsylvania ophthalmology rates have a median of 98% 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 Pennsylvania
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Pennsylvania | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 99212 Office o/p est sf 10 min | $40 | $43 | -5% | 68% | 117 | 233 | |
| CPT 92020 Gonioscopy | $24 | $26 | -9% | 90% | 117 | 242 | |
| CPT 92202 Opscpy extnd on/mac draw | $15 | $17 | -9% | 97% | 116 | 243 | |
| CPT 99213 Office o/p est low 20 min | $66 | $73 | -9% | 69% | 116 | 215 | |
| CPT 92201 Opscpy extnd rta draw uni/bi | $24 | $27 | -10% | 96% | 116 | 244 | |
| CPT 99203 Office o/p new low 30 min | $90 | $101 | -11% | 77% | 117 | 234 | |
| CPT 99214 Office o/p est mod 30 min | $95 | $107 | -11% | 70% | 116 | 205 | |
| CPT 99215 Office o/p est hi 40 min | $132 | $148 | -11% | 69% | 116 | 206 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $61 | $69 | -11% | 89% | 116 | 238 | |
| CPT 92012 Intrm oph exam est patient | $67 | $76 | -12% | 161% | 116 | 248 | |
| CPT 99204 Office o/p new mod 45 min | $139 | $158 | -12% | 78% | 116 | 209 | |
| CPT 99205 Office o/p new hi 60 min | $181 | $205 | -12% | 76% | 117 | 236 | |
| CPT 92134 Cptrz oph dx img pst sgm rta | $39 | $45 | -12% | 120% | 117 | 237 | |
| CPT 92273 Full field erg w/i&r | $125 | $142 | -12% | 101% | 116 | 244 | |
| CPT 92025 Cptrized corneal topography | $35 | $40 | -12% | 95% | 117 | 243 | |
| CPT 92242 Fluorescein&icg angiography | $249 | $288 | -13% | 74% | 116 | 241 | |
| CPT 68761 Close tear duct opening | $140 | $164 | -15% | 98% | 117 | 241 | |
| CPT 66991 Xcapsl ctrc rmvl insj 1+ | $716 | $840 | -15% | 123% | 116 | 239 | |
| CPT 92235 Fluorescein angrph mltiframe | $123 | $145 | -15% | 76% | 116 | 241 | |
| CPT 92083 Extended visual field xm | $62 | $73 | -15% | 97% | 117 | 245 | |
| CPT 67904 Repair eyelid defect | $691 | $816 | -15% | 93% | 116 | 242 | |
| CPT 92133 Cptrzd oph dx img pst sgm on | $36 | $42 | -16% | 116% | 117 | 234 | |
| CPT 92014 Compre oph exam est pt 1/> | $85 | $101 | -16% | 137% | 116 | 241 | |
| CPT 92136 Ophthalmic biometry | $58 | $69 | -16% | 120% | 116 | 239 | |
| CPT 67840 Remove eyelid lesion | $211 | $253 | -17% | 157% | 116 | 244 | |
| CPT 65820 Goniotomy | $797 | $955 | -17% | 110% | 116 | 244 | |
| CPT 92004 Compre oph exam new pt 1/> | $103 | $124 | -17% | 69% | 116 | 242 | |
| CPT 15823 Blepharp upr eyelid xcsv skn | $559 | $677 | -18% | 88% | 116 | 244 | |
| CPT 66821 After cataract laser surgery | $324 | $393 | -18% | 96% | 116 | 241 | |
| CPT 65756 Corneal trnspl endothelial | $1,170 | $1,425 | -18% | 118% | 116 | 244 | |
| CPT 66982 Xcapsl ctrc rmvl cplx wo ecp | $797 | $981 | -19% | 126% | 116 | 239 | |
| CPT 65778 Cover eye w/membrane | $57 | $70 | -19% | 159% | 116 | 210 | |
| CPT 67210 Treatment of retinal lesion | $534 | $659 | -19% | 103% | 116 | 243 | |
| CPT 67028 Injection eye drug | $110 | $137 | -20% | 96% | 116 | 245 | |
| CPT 67036 Removal of inner eye fluid | $889 | $1,117 | -20% | 117% | 116 | 243 | |
| CPT 67042 Vit for macular hole | $1,186 | $1,494 | -21% | 124% | 116 | 243 | |
| CPT 92250 Fundus photography w/i&r | $42 | $53 | -21% | 112% | 117 | 245 | |
| CPT 66984 Xcapsl ctrc rmvl w/o ecp | $582 | $738 | -21% | 126% | 116 | 241 | |
| CPT 93000 Electrocardiogram complete | $16 | $21 | -21% | 107% | 117 | 241 | |
| CPT 65855 Trabeculoplasty laser surg | $240 | $307 | -22% | 98% | 116 | 244 | |
| CPT 67108 Repair detached retina | $1,240 | $1,594 | -22% | 125% | 116 | 243 | |
| CPT 76512 Oph us dx b-scan | $51 | $70 | -27% | 105% | 117 | 242 |
Frequently asked questions
How do Pennsylvania ophthalmology rates compare with the rest of the country?
Pennsylvania ranks 47th of 50 states with an index of 84; 0 of 42 codes are above the national median.
Which ophthalmology code has the biggest premium in Pennsylvania?
CPT 99212 (Office o/p est sf 10 min), at 95% 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 Pennsylvania ophthalmology contracts
Compare your rates with these medians.