CPT 92004 Ophthalmology
Compre oph exam new pt 1/> Cost
Body System: Eye
Medicare Facility Rate
$78
CMS PFS CY2026
Medicare Non-Facility Rate
$150
Office/clinic setting
Hospital Outpatient
$136
OPPS rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.82
Work RVU
0.47
Facility PE RVU
0.04
Malpractice RVU
4.48
Total RVU
Frequently Asked Questions
How much does Compre oph exam new pt 1/> cost?
The Medicare facility rate is $78. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $136.
How much does Compre oph exam new pt 1/> cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $78.