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Eye Exam, Established Patient, Intermediate

New Jersey 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?

$64.57

Typical physician fee. In New Jersey, July 2026.

Insurers have agreed to pay about $64.57 for this service. Most negotiated rates run $46.77 to $87.10.

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 $263 · 10th to 90th $251 to $282Professionalmedian $65 · 10th to 90th $40 to $110
$50$100$200facility $263professional $65

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
$39.81
Median
$64.57
Typical High
$102.33
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$67.61
Median
$95.50
Typical High
$144.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$102.33
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$102.33
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$72.44
Typical High
$165.96
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$54.95
Typical High
$112.20
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$263.03
Typical High
$281.84
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$109.65
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$50.12
Typical High
$97.72

Where New Jersey 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.

New Jersey· 47th of 51

$64.57

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.