Ophthalmology · South Dakota

Ophthalmology commercial reimbursement in South Dakota

How South Dakota ophthalmology rates compare with the national market.

Ophthalmology South Dakota

Ophthalmology in South Dakota

42 codes · 39 sampled providers

Index vs national

153

53% above

Rank among states

5 of 50

1 = highest

Codes above national

42 of 42

median code at 154%

Providers

sampled

What the data shows

Ophthalmology ranks 5th of 50 states in South Dakota with an index of 153 (100 = the specialty's national median), across 42 codes and 39 sampled providers.

Of the 42 ophthalmology codes with enough data in South Dakota, 42 pay above the national median and 0 below; the typical code sits at 154% of the national median.

Largest premium over the national median: CPT 65820 (Goniotomy) at 184%; largest discount: CPT 99212 (Office o/p est sf 10 min) at 114%.

Measured against Medicare, South Dakota ophthalmology rates have a median of 207% of the Medicare rate across these codes.

Codes above and below the national median

The five largest gaps in each direction

Highest vs national

Code	South Dako	National	Gap	Prov.
65820 Goniotomy	$1,754	$955	+84%	39
92025 Cptrized corneal topography	$73	$40	+81%	39
92273 Full field erg w/i&r	$255	$142	+79%	39
66821 After cataract laser surgery	$700	$393	+78%	39
65756 Corneal trnspl endothelial	$2,532	$1,425	+78%	39

Lowest vs national

Code	South Dako	National	Gap	Prov.
99212 Office o/p est sf 10 min	$48	$43	+14%	39
92235 Fluorescein angrph mltiframe	$186	$145	+29%	39
65778 Cover eye w/membrane	$91	$70	+31%	39
99213 Office o/p est low 20 min	$97	$73	+34%	39
92020 Gonioscopy	$36	$26	+35%	39

All ophthalmology codes in South Dakota

Median across payers vs the specialty's national median and the Medicare rate; sorted by premium

Code	South Dakota	National	Gap	% of Medicare	Providers	TINs
CPT 65820 Goniotomy	$1,754	$955	+84%	242%	39	58
CPT 92025 Cptrized corneal topography	$73	$40	+81%	196%	39	60
CPT 92273 Full field erg w/i&r	$255	$142	+79%	207%	39	58
CPT 66821 After cataract laser surgery	$700	$393	+78%	209%	39	60
CPT 65756 Corneal trnspl endothelial	$2,532	$1,425	+78%	255%	39	59
CPT 66991 Xcapsl ctrc rmvl insj 1+	$1,486	$840	+77%	255%	39	58
CPT 67036 Removal of inner eye fluid	$1,931	$1,117	+73%	254%	39	59
CPT 15823 Blepharp upr eyelid xcsv skn	$1,169	$677	+73%	185%	39	58
CPT 92083 Extended visual field xm	$123	$73	+68%	192%	39	60
CPT 67210 Treatment of retinal lesion	$1,093	$659	+66%	211%	39	59
CPT 67904 Repair eyelid defect	$1,347	$816	+65%	181%	39	57
CPT 66982 Xcapsl ctrc rmvl cplx wo ecp	$1,610	$981	+64%	255%	39	59
CPT 67042 Vit for macular hole	$2,437	$1,494	+63%	255%	39	58
CPT 68761 Close tear duct opening	$264	$164	+61%	185%	39	60
CPT 66984 Xcapsl ctrc rmvl w/o ecp	$1,181	$738	+60%	255%	39	60
CPT 67108 Repair detached retina	$2,533	$1,594	+59%	255%	39	58
CPT 92134 Cptrz oph dx img pst sgm rta	$71	$45	+58%	217%	39	60
CPT 92133 Cptrzd oph dx img pst sgm on	$67	$42	+57%	217%	39	60
CPT 92014 Compre oph exam est pt 1/>	$156	$101	+55%	252%	39	60
CPT 93000 Electrocardiogram complete	$32	$21	+54%	209%	39	56
CPT 99204 Office o/p new mod 45 min	$243	$158	+54%	137%	39	58
CPT 92250 Fundus photography w/i&r	$80	$53	+53%	217%	39	60
CPT 92242 Fluorescein&icg angiography	$438	$288	+52%	130%	39	57
CPT 20610 Drain/inj joint/bursa w/o us	$105	$69	+52%	153%	39	58
CPT 92136 Ophthalmic biometry	$104	$69	+52%	217%	39	59
CPT 92202 Opscpy extnd on/mac draw	$25	$17	+51%	162%	39	57
CPT 92201 Opscpy extnd rta draw uni/bi	$40	$27	+50%	159%	39	59
CPT 92004 Compre oph exam new pt 1/>	$186	$124	+50%	124%	39	60
CPT 67028 Injection eye drug	$203	$137	+48%	177%	39	60
CPT 99205 Office o/p new hi 60 min	$303	$205	+48%	128%	39	58
CPT 76512 Oph us dx b-scan	$103	$70	+47%	211%	39	60
CPT 65855 Trabeculoplasty laser surg	$445	$307	+45%	181%	39	59
CPT 67840 Remove eyelid lesion	$366	$253	+45%	273%	39	58
CPT 99215 Office o/p est hi 40 min	$212	$148	+43%	110%	39	58
CPT 99203 Office o/p new low 30 min	$144	$101	+42%	122%	39	58
CPT 99214 Office o/p est mod 30 min	$150	$107	+41%	111%	39	58
CPT 92012 Intrm oph exam est patient	$103	$76	+37%	250%	39	60
CPT 92020 Gonioscopy	$36	$26	+35%	133%	39	58
CPT 99213 Office o/p est low 20 min	$97	$73	+34%	102%	39	58
CPT 65778 Cover eye w/membrane	$91	$70	+31%	255%	39	59
CPT 92235 Fluorescein angrph mltiframe	$186	$145	+29%	115%	39	59
CPT 99212 Office o/p est sf 10 min	$48	$43	+14%	81%	39	58

Frequently asked questions

How do South Dakota ophthalmology rates compare with the rest of the country?

South Dakota ranks 5th of 50 states with an index of 153; 42 of 42 codes are above the national median.

Which ophthalmology code has the biggest premium in South Dakota?

CPT 65820 (Goniotomy), at 184% 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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