Exchange of prosthetic lens
Medicare pricing data for 4,021 providers across 47 states
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
Exchange of prosthetic lens (HCPCS code 66986) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $783.45, but hospitals typically charge $3,206 — a 4.1x 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 $783.45, your out-of-pocket cost would be approximately $156.69. 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 4.1x more than what Medicare allows for this procedure. Medicare actually pays $621.63 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| California | $957 | $4,652 | 480 | 1,477 | +22.1% |
| New Jersey | $918 | $4,228 | 110 | 498 | +17.2% |
| Oregon | $906 | $2,427 | 61 | 181 | +15.7% |
| New York | $900 | $3,626 | 190 | 602 | +14.9% |
| New Hampshire | $900 | $3,496 | 20 | 56 | +14.9% |
| Hawaii | $890 | $3,691 | 19 | 55 | +13.6% |
| Massachusetts | $890 | $2,688 | 122 | 355 | +13.6% |
| Nevada | $887 | $3,157 | 40 | 105 | +13.2% |
| Washington | $876 | $2,576 | 109 | 372 | +11.8% |
| Rhode Island | $873 | $2,394 | 9 | 15 | +11.4% |
| Connecticut | $853 | $5,026 | 48 | 149 | +8.9% |
| Utah | $852 | $3,731 | 56 | 340 | +8.7% |
| Illinois | $852 | $3,383 | 122 | 328 | +8.7% |
| Colorado | $848 | $3,133 | 79 | 337 | +8.3% |
| Maryland | $845 | $3,461 | 89 | 392 | +7.9% |
| Pennsylvania | $839 | $2,750 | 179 | 748 | +7.0% |
| Georgia | $830 | $3,135 | 113 | 330 | +6.0% |
| Michigan | $830 | $2,449 | 108 | 308 | +5.9% |
| New Mexico | $817 | $1,953 | 18 | 171 | +4.2% |
| Texas | $813 | $4,646 | 265 | 956 | +3.8% |
| South Dakota | $813 | $2,565 | 14 | 70 | +3.8% |
| Virginia | $811 | $2,595 | 105 | 347 | +3.6% |
| Delaware | $810 | $1,816 | 16 | 42 | +3.4% |
| Idaho | $805 | $2,171 | 24 | 61 | +2.8% |
| Nebraska | $805 | $3,187 | 23 | 68 | +2.7% |
| Louisiana | $792 | $2,726 | 51 | 187 | +1.0% |
| Ohio | $790 | $3,401 | 112 | 376 | +0.9% |
| Florida | $786 | $3,371 | 333 | 1,396 | +0.3% |
| South Carolina | $785 | $3,116 | 62 | 205 | +0.2% |
| North Carolina | $784 | $2,881 | 93 | 313 | +0.0% |
| Tennessee | $781 | $3,310 | 92 | 362 | -0.3% |
| Oklahoma | $775 | $3,053 | 40 | 250 | -1.0% |
| Missouri | $775 | $2,912 | 84 | 236 | -1.0% |
| Kansas | $772 | $2,812 | 44 | 127 | -1.4% |
| Wisconsin | $767 | $5,503 | 54 | 134 | -2.1% |
| Indiana | $764 | $3,824 | 57 | 288 | -2.5% |
| Iowa | $757 | $3,106 | 33 | 122 | -3.4% |
| Montana | $748 | $2,300 | 19 | 53 | -4.5% |
| Alabama | $739 | $2,613 | 65 | 180 | -5.7% |
| Kentucky | $736 | $2,807 | 59 | 155 | -6.1% |
| North Dakota | $736 | $2,574 | 16 | 50 | -6.1% |
| Minnesota | $735 | $3,572 | 53 | 185 | -6.2% |
| Arizona | $734 | $2,293 | 105 | 544 | -6.4% |
| West Virginia | $724 | $1,929 | 18 | 36 | -7.6% |
| Maine | $722 | $2,968 | 14 | 45 | -7.8% |
| Arkansas | $720 | $2,084 | 27 | 77 | -8.1% |
| Mississippi | $715 | $2,675 | 51 | 168 | -8.8% |
⚠️ 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