92240

Exam of blood vessels between the white part of eye and retina using a special camera after injection of a dye

Medicare pricing data for 284 providers across 23 states

🤖AI Overview

Prices vary significantly by location — from $45 in Utah to $230 in New York. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Exam of blood vessels between the white part of eye and retina using a special camera after injection of a dye (HCPCS code 92240) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $188.77, but hospitals typically charge $571.70 — a 3.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$37.75

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $188.77, your out-of-pocket cost would be approximately $37.75. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$188.77
Average Hospital Charge
$571.70
Markup Ratio
3.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$571.70
Medicare Allowed$188.77
Medicare Payment$144.81

Hospitals charge 3.0x more than what Medicare allows for this procedure. Medicare actually pays $144.81 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$230$48031549+21.8%
New Jersey$223$57012299+18.0%
Virginia$217$403517+14.7%
Hawaii$212$372257+12.4%
Connecticut$208$660322+10.0%
Illinois$202$6726108+7.0%
Maryland$200$3741538+6.2%
Indiana$189$2325120-0.1%
Washington$187$497935-1.0%
Oregon$186$537642-1.6%
Florida$185$59535374-2.2%
Texas$184$579264,306-2.5%
Pennsylvania$182$4329342-3.4%
Arizona$182$501550-3.6%
North Carolina$175$5781066-7.1%
Louisiana$174$8057456-7.7%
California$172$8313581-9.0%
Ohio$168$647718-10.8%
Oklahoma$167$429419-11.7%
Mississippi$165$375113-12.7%
Michigan$144$3921524-23.5%
Massachusetts$51$1951543-73.1%
Utah$45$176923-75.9%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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