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Eye Exam, Established Patient, Intermediate

North Carolina rates for HCPCS 92012

This is a medical eye examination for a patient who has previously been seen by the practice, covering a moderate level of evaluation and continuing or adjusting an existing treatment plan. It's typically used for routine follow-up of an existing eye condition rather than a new or highly complex problem.

Rates data updated July 2026.

How much does Eye Exam, Established Patient, Intermediate cost?

$69.18

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $69.18 for this service. The price depends on where it is billed: about $67.61 from a physician practice, and about $75.86 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$67.61$50.12 to $87.10
FacilityA hospital or hospital-owned outpatient department$75.86$52.48 to $95.50

How much rates vary

Facilitymedian $76 · 10th to 90th $47 to $120Professionalmedian $68 · 10th to 90th $41 to $105
$50$100$200facility $76professional $68

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
$41.69
Median
$75.86
Typical High
$109.65
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$16.22
Median
$91.20
Typical High
$199.53
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$144.54
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$70.79
Typical High
$154.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$75.86
Typical High
$117.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$52.48
Typical High
$93.33
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$724.44

Where North Carolina sits

The same service costs 1.9 times more in Montana 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· 40th of 51

$69.18

MT $97.72DE $51.29

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.