Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Singl prscrp lens
Low
$0
Average
$48
Median
$38
High
$207
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
18 payers; the 90th percentile is 6.0× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Aetna fee schedule · outpatient · +5 other terms | 20 | $15 | $34 | $34 | 97% | — | $15 – $150 |
| 2 | Anthem facility · case rate · outpatient · +4 other terms | 15 | $33 | $36 | $8 | 23% | — | $23 – $56 |
| 3 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $34 | $36 | $8 | 23% | — | $23 – $57 |
| 4 | Molina facility · case rate · outpatient · +1 other terms | 15 | $33 | $36 | $8 | 23% | — | $23 – $56 |
| 5 | UnitedHealthcare facility · case rate · outpatient · +4 other terms | 15 | $34 | $37 | $9 | 23% | — | $23 – $57 |
| 6 | Wellmark fee schedule · both · +1 other terms | 13 | $52 | $56 | $25 | 45% | — | $52 – $207 |
| 7 | Blue Cross Blue Shield facility · fee schedule · outpatient · +4 other terms | 11 | $30 | $28 | $7 | 24% | — | $0 – $30 |
| 8 | Optum facility · case rate · outpatient · +1 other terms | 11 | $31 | $34 | $8 | 22% | — | $28 – $51 |
| 9 | Bcbs Mn fee schedule · both · +2 other terms | 8 | $30 | $30 | $0 | 1% | — | $30 – $30 |
| 10 | Aetna Better Health fee schedule · inpatient · +1 other terms | 7 | $15 | $15 | — | — | — | $15 – $15 |
| 11 | Humana fee schedule · inpatient · +2 other terms | 5 | $15 | $15 | — | — | — | $15 – $15 |
| 12 | First Health professional · fee schedule · both | 3 | $17 | $17 | — | — | — | $17 – $17 |
| 13 | Highmark professional · fee schedule · both | 3 | $16 | $16 | — | — | — | $16 – $16 |
| 14 | Bcbs Il professional · fee schedule · both | 1 | $207 | $207 | — | — | — | $207 – $207 |
| 15 | Bcbs La facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 16 | Bcbs Nv fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 17 | Bcbs Vt professional · fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 18 | Cigna fee schedule · both · +1 other terms | 1 | $59 | $59 | — | — | — | $59 – $59 |
← Hospitals reporting HCPCS S0504 · Snapshot 20261113T090226Z-3ce6c0b8