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Eye Exam, New Patient, Comprehensive

Pennsylvania 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?

$145

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $115 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 13 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$145$100 to $186
FacilityA hospital or hospital-owned outpatient department$115$110 to $151

How much rates vary

Facilitymedian $115 · 10th to 90th $50 to $151Professionalmedian $145 · 10th to 90th $74 to $282
$50$100$200$500facility $115professional $145

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
Facility
Modifier
Global
Typical Low
$50.12
Median
$114.82
Typical High
$151.36
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$147.91
Typical High
$295.12
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$138.04
Median
$169.82
Typical High
$331.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$144.54
Typical High
$223.87
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$125.89
Median
$141.25
Typical High
$154.88
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$363.08
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$281.84
Typical High
$281.84
Capital Blue Cross
Setting
Professional
Modifier
50 · Both sides
Typical Low
$141.25
Median
$169.82
Typical High
$281.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$208.93
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$70.79
Typical High
$177.83
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$147.91
Typical High
$251.19
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$177.83
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$134.90
Typical High
$134.90
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$263.03
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$114.82
Typical High
$151.36
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$141.25
Typical High
$257.04
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$128.82
Median
$186.21
Typical High
$331.13
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$128.82
Typical High
$204.17
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$138.04
Typical High
$162.18
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$123.03
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$112.20
Typical High
$190.55

Where Pennsylvania 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.

Pennsylvania· 7th of 51

$145

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.