go back

Eye Exam, New Patient, Comprehensive

Illinois rates for HCPCS 92004

This is a thorough initial eye examination for a patient new to the practice, including a detailed history, a full exam of the eye's structures and vision, and the start of a treatment or monitoring plan. It's more extensive than a basic vision check and is often used to evaluate new or complex eye concerns.

Rates data updated July 2026.

How much does Eye Exam, New Patient, Comprehensive cost?

$138

Typical physician fee. In Illinois, July 2026.

Insurers have agreed to pay about $138 for this service. Most negotiated rates run $97.72 to $186.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $91 · 10th to 90th $91 to $316Professionalmedian $138 · 10th to 90th $72 to $245
$50$100$200$500facility $91professional $138

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$138.04
Typical High
$245.47
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$190.55
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$138.04
Typical High
$186.21
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$147.91
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$138.04
Typical High
$251.19
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$162.18
Typical High
$295.12
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$125.89
Typical High
$245.47

Where Illinois sits

The same service costs 1.6 times more in California than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Illinois· 20th of 51

$138

CA $158DE $97.72

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.