Single-vision eyeglass lens, per lens

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Single visn sphere 4.12-7.00

Payers reporting HCPCS V2101

Payer pricing summary

Low

$14

Average

$74

Median

$65

High

$217

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +14 other terms	338	$62	$55	$16	30%	—	$6 – $187
2	Aetna fee schedule · outpatient · +12 other terms	322	$66	$71	$39	55%	—	$22 – $408
3	Humana fee schedule · outpatient · +9 other terms	316	$65	$94	$108	115%	—	$40 – $518
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	213	$66	$74	$52	71%	—	$0 – $325
5	WellCare fee schedule · outpatient · +4 other terms	202	$66	$66	$14	22%	—	$50 – $131
6	Devoted fee schedule · outpatient · +2 other terms	164	$66	$63	$7	11%	—	$51 – $71
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$64	$64	$6	9%	—	$51 – $69
8	Molina fee schedule · outpatient · +5 other terms	110	$76	$89	$36	41%	—	$52 – $177
9	Cigna fee schedule · outpatient · +10 other terms	95	$66	$67	$21	31%	—	$50 – $168
10	Anthem fee schedule · outpatient · +7 other terms	74	$65	$63	$10	16%	—	$50 – $109
11	Kaiser fee schedule · outpatient · +4 other terms	61	$69	$97	$64	66%	—	$56 – $414
12	Superior Healthplan fee schedule · outpatient	40	$71	$71	$0	0%	—	$66 – $71
13	Clover fee schedule · outpatient · +2 other terms	37	$66	$63	$7	12%	—	$51 – $71
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$98	$102	$19	18%	—	$50 – $126
15	Oscar fee schedule · outpatient · +3 other terms	32	$66	$69	$18	26%	—	$53 – $109
16	Optum fee schedule · outpatient · +3 other terms	26	$65	$70	$35	49%	—	$50 – $168
17	Caresource facility · case rate · outpatient · +4 other terms	20	$37	$55	$35	64%	—	$23 – $135
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$70	$65	$9	13%	—	$47 – $71
19	Bcbs Tx fee schedule · outpatient	18	$66	$66	—	—	—	$66 – $66
20	Medicare fee schedule · outpatient · +1 other terms	18	$65	$65	$1	1%	—	$65 – $66
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$61	$60	$1	2%	—	$58 – $61
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$55	$63	$16	25%	—	$30 – $86
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$50	$50	$12	23%	—	$24 – $58
24	Wellmark fee schedule · both · +1 other terms	13	$45	$45	$5	12%	—	$45 – $79
25	Aetna Better Health fee schedule · outpatient · +4 other terms	12	$45	$47	$2	5%	—	$45 – $50

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