The free hearing screening at the pharmacy and the $350 audiologist evaluation are not the same thing. Here’s what you’re actually getting for the difference.
The pharmacy kiosk test — or the one at a health fair, or the online tone-pip test — screens for obvious hearing difficulty. Pass/fail. If you fail, you’re told to follow up. If you pass, you have no idea whether you have early high-frequency loss, whether your word recognition is declining, or whether your middle ear function is normal. You’ve learned almost nothing clinically useful.
A comprehensive audiological evaluation is a diagnostic workup. It tells you exactly where your hearing is, why, and what options exist. ASHA defines the scope of a full diagnostic evaluation to include multiple components — each providing different information.
What a Full Evaluation Includes (and Costs)
| Component | What It Tests | Typical Cost |
|---|---|---|
| Case history & otoscopy | Ear canal/drum visual inspection | Included |
| Pure-tone audiometry (air conduction) | Hearing thresholds each ear, 250–8,000 Hz | $80–$150 |
| Bone conduction testing | Separates sensorineural from conductive loss | Included |
| Speech reception threshold (SRT) | Softest level you understand 50% of words | Included |
| Word recognition score (WRS) | % words understood at comfortable level | Included |
| Tympanometry | Middle ear pressure, eardrum mobility | $30–$75 |
| Acoustic reflex testing | Stapedius reflex, indicates neural pathway integrity | $25–$50 |
| Full evaluation (comprehensive) | All of the above | $100–$350 |
Pure-Tone Audiometry: The Core Test
You sit in a soundproof booth and raise your hand (or press a button) when you hear a tone. The audiologist tests frequencies from 250 Hz (low pitch, similar to a foghorn) to 8,000 Hz (high pitch, similar to a whistle) at decreasing volume levels to find your threshold — the softest sound you can detect 50% of the time.
This generates the audiogram. Each ear is tested separately. Bone conduction testing (using a small vibrator placed behind the ear rather than headphones) helps distinguish between sensorineural loss (cochlear/nerve damage) and conductive loss (problem in the outer or middle ear). The distinction matters for treatment — conductive loss is often medically treatable; sensorineural usually isn’t.
Speech Testing: What Pure Tones Can’t Tell You
Your word recognition score (WRS) measures how well you understand speech at a comfortable loudness level — not just whether you can detect sound. This is clinically crucial.
Two people can have identical audiograms but very different word recognition scores. If your WRS is 92%, hearing aids can restore most of your speech understanding. If it’s 48%, the picture is more complicated — and possibly points toward neurological rather than peripheral hearing loss. WRS also determines cochlear implant candidacy (below 50% in the best-aided condition).
Audiologists describe a phenomenon called “hearing but not understanding.” Many people can detect speech well enough — they know someone is talking — but can’t decode the words. This shows up in speech discrimination scores, not pure-tone averages. If you’re saying “I can hear, I just can’t understand,” a speech audiometry evaluation quantifies exactly how significant that gap is and why.
Tympanometry: The Middle Ear Test
Tympanometry is a quick, painless test that measures eardrum movement in response to air pressure changes in the ear canal. It takes about 30 seconds per ear and tells the audiologist whether your middle ear is functioning normally.
Abnormal results — flat tympanogram (Type B) or negative pressure (Type C) — indicate fluid behind the eardrum, eustachian tube dysfunction, or a perforated eardrum. These are treatable by an ENT. Normal tympanometry in the presence of hearing loss confirms the loss is sensorineural.
Medicare Coverage
Medicare Part B covers diagnostic audiological evaluations when ordered by a physician for a medical reason. You pay nothing for the test itself in most cases (the audiologist is paid under Medicare’s durable medical equipment/services schedule); you may owe the 20% Part B coinsurance after meeting your deductible.
The key requirement: a physician referral. You can’t self-refer for Medicare-covered audiological testing. Your primary care doctor, ENT, or neurologist can order the evaluation.
Medicare does not cover hearing aids or routine hearing exams for the purpose of fitting hearing aids — only diagnostic evaluations for medical purposes. If you go to an audiologist specifically to get fitted for hearing aids, that evaluation is typically not Medicare-covered. The diagnostic evaluation (ordered by your doctor) and the hearing aid fitting evaluation are billed differently.
Audiologist vs. ENT: Who to See First
See an audiologist first if: You’re experiencing gradual hearing loss, want a hearing baseline, need hearing aid fitting, have tinnitus without other symptoms, or want to monitor age-related hearing decline.
See an ENT (otolaryngologist) first if: Your hearing loss started suddenly (within 90 days), you have pain or drainage from the ear, you have vertigo or dizziness, you have facial weakness or neurological symptoms alongside hearing changes, or you have asymmetric hearing loss (much worse in one ear).
ENTs handle medical and surgical conditions. Audiologists handle hearing assessment, rehabilitation, and hearing aids. For most adults with gradual hearing decline, the audiologist is the right first stop.
AuD vs. Hearing Instrument Specialist
An audiologist (Au.D. or Ph.D.) has a doctoral-level degree, typically 4 years of graduate training plus a supervised externship. They’re licensed to evaluate all types of hearing and balance disorders, work with cochlear implants and BAHAs, and diagnose audiological conditions.
A hearing instrument specialist (HIS) has a certificate-level credential, typically from a state-regulated program. They’re trained to fit and dispense hearing aids but aren’t qualified to provide diagnostic audiological evaluation or work with cochlear implants.
Both can fit hearing aids. The difference matters if you have a complex hearing profile, need diagnostic evaluation for medical purposes, or are being evaluated for cochlear implants or BAHAs.
The Bottom Line
A full audiological evaluation takes about 90 minutes, costs $100–$350 without insurance, and often costs nothing with a Medicare Part B referral. It’s the most information-dense tool available for understanding your hearing. If you’ve been putting off getting tested — for any reason — the evaluation itself is the cheapest and most useful step you can take.
Frequently Asked Questions
An audiogram is a graph of your hearing thresholds across frequencies — from low pitch (250 Hz) to high pitch (8,000 Hz), tested separately for each ear. It shows the softest sound you can hear at each pitch, measured in decibels (dB). A normal result falls within 0–25 dB HL across all frequencies. Mild loss is 26–40 dB; moderate is 41–55 dB; moderately-severe is 56–70 dB; severe is 71–90 dB; profound is 91+ dB. The audiogram also includes speech audiometry scores — how well you understand words at a comfortable listening level — which is critical for hearing aid fitting.
The American Academy of Audiology recommends a baseline hearing evaluation by age 50 and follow-up testing every 3 years if your hearing is normal, more frequently if you notice changes. You should be evaluated sooner if you're asking people to repeat themselves regularly, turning the TV up louder than others want it, struggling to follow conversations in noise, experiencing tinnitus, or noticing any sudden change in hearing. Don't wait until it's obviously a problem — the earlier you address hearing loss, the better the long-term outcomes.
Yes, in most cases. The traditional audiology business model bundles the hearing aid cost with professional services — evaluation, fitting, real-ear measurement, and follow-up visits. This bundled pricing makes it hard to compare audiologist pricing with other channels. Some audiologists now offer unbundled pricing where you pay separately for the device and the services. If cost is a concern, ask upfront whether unbundled pricing is available. Costco represents an alternative model where the fitting professional's time is included in a flat device price that's well below the traditional audiology channel.