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Eye Exam, Established Patient, Intermediate

Virginia 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?

$75.86

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $57.54 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 8 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$75.86$47.86 to $93.33
FacilityA hospital or hospital-owned outpatient department$57.54$47.86 to $81.28

How much rates vary

Facilitymedian $58 · 10th to 90th $42 to $107Professionalmedian $76 · 10th to 90th $40 to $126
$20$50$100$200facility $58professional $76

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
$39.81
Median
$75.86
Typical High
$123.03
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$22.91
Median
$114.82
Typical High
$162.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$87.10
Typical High
$158.49
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$42.66
Typical High
$51.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$72.44
Typical High
$131.83
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$102.33
Typical High
$123.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$97.72
Medcost
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$69.18
Typical High
$117.49
Sentara
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$53.70
Typical High
$77.62
Sentara
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$89.13
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$54.95
Typical High
$93.33

Where Virginia 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.

Virginia· 29th of 51

$75.86

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.