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Eye Exam, New Patient, Comprehensive

North Carolina 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?

$115

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $115 from a physician practice, and about $141 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$115$85.11 to $145
FacilityA hospital or hospital-owned outpatient department$141$100 to $170

How much rates vary

Facilitymedian $141 · 10th to 90th $87 to $209Professionalmedian $115 · 10th to 90th $62 to $234
$50$100$200facility $141professional $115

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$123.03
Typical High
$251.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$158.49
Typical High
$316.23
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$141.25
Typical High
$186.21
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$131.83
Median
$131.83
Typical High
$141.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$134.90
Typical High
$269.15
Medcost
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$141.25
Typical High
$208.93
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$97.72
Typical High
$158.49
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$588.84
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$1,202.26

Where North Carolina 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.

North Carolina· 42nd of 51

$115

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.