What is the standard insurance baseline for CPT 92242?

The standard insurance baseline reimbursement rate is $258.66. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/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

CPT 92242Medical Service

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

Q: What do doctors typically charge for 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?

The nationwide median physician charge for 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 (CPT 92242) is $532.53. Doctor billed charges vary based on geographic region, setting, and overhead.

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. Clinical pricing breakdown and utilization metrics across 206 practicing doctors nationwide.

$532.53

Peer Median Charge

Gross billed rate

$258.66

Standard Baseline

Customary allowable

2.1x

National Markup

Charge vs baseline

206

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $532.53. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $258.66 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 92242 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"