Exam of retinal blood vessels and blood vessels between the white part of eye and retina using a special camera after injection of a dye
Medicare pricing data for 856 providers across 35 states
Prices vary significantly by location — from $91 in Ohio to $301 in New York. Where you get this procedure matters more than almost any other factor. 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 retinal blood vessels and blood vessels between the white part of eye and retina using a special camera after injection of a dye (HCPCS code 92242) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $265.73, but hospitals typically charge $541.26 — a 2.0x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $265.73, your out-of-pocket cost would be approximately $53.15. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.0x more than what Medicare allows for this procedure. Medicare actually pays $206.42 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New York | $301 | $557 | 62 | 2,922 | +13.1% |
| California | $294 | $611 | 108 | 4,295 | +10.8% |
| Massachusetts | $289 | $772 | 31 | 888 | +8.9% |
| New Jersey | $288 | $537 | 18 | 1,834 | +8.3% |
| Connecticut | $285 | $654 | 10 | 33 | +7.1% |
| Hawaii | $280 | $533 | 12 | 287 | +5.2% |
| Virginia | $274 | $553 | 17 | 65 | +3.0% |
| Washington | $272 | $533 | 39 | 2,021 | +2.2% |
| Nevada | $266 | $425 | 3 | 93 | +0.3% |
| Maryland | $266 | $396 | 28 | 2,825 | +0.1% |
| Pennsylvania | $260 | $1,315 | 25 | 137 | -2.2% |
| Colorado | $260 | $712 | 19 | 220 | -2.3% |
| South Dakota | $256 | $1,992 | 1 | 11 | -3.5% |
| Florida | $256 | $508 | 43 | 4,473 | -3.8% |
| Illinois | $252 | $640 | 24 | 86 | -5.0% |
| Arizona | $252 | $563 | 26 | 1,701 | -5.1% |
| Texas | $251 | $594 | 78 | 3,035 | -5.4% |
| Maine | $248 | $451 | 6 | 59 | -6.7% |
| Georgia | $245 | $650 | 7 | 26 | -8.0% |
| North Carolina | $244 | $519 | 19 | 471 | -8.2% |
| South Carolina | $243 | $420 | 10 | 274 | -8.5% |
| Missouri | $241 | $346 | 14 | 918 | -9.3% |
| Indiana | $240 | $597 | 5 | 448 | -9.8% |
| Tennessee | $235 | $660 | 6 | 53 | -11.6% |
| Louisiana | $233 | $522 | 18 | 1,077 | -12.4% |
| Oklahoma | $233 | $428 | 6 | 144 | -12.4% |
| Michigan | $233 | $492 | 31 | 303 | -12.4% |
| Minnesota | $226 | $981 | 22 | 101 | -14.8% |
| Kentucky | $224 | $421 | 4 | 32 | -15.7% |
| West Virginia | $222 | $420 | 5 | 26 | -16.5% |
| Mississippi | $220 | $315 | 2 | 363 | -17.1% |
| Utah | $201 | $487 | 8 | 80 | -24.3% |
| Wisconsin | $163 | $794 | 13 | 45 | -38.7% |
| Oregon | $145 | $304 | 20 | 69 | -45.5% |
| Ohio | $91 | $519 | 33 | 122 | -65.7% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber