Single-vision spherocylinder eyeglass 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

Spherocylinder 4.00d/4.25-6d

Payers reporting HCPCS V2105

Payer pricing summary

Low

$14

Average

$67

Median

$57

High

$188

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	337	$56	$57	$14	24%	—	$11 – $201
2	Aetna fee schedule · outpatient · +12 other terms	321	$57	$67	$38	56%	—	$25 – $404
3	Humana fee schedule · outpatient · +9 other terms	316	$56	$82	$81	99%	—	$40 – $397
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$58	$72	$55	77%	—	$0 – $312
5	WellCare fee schedule · outpatient · +4 other terms	202	$55	$58	$14	24%	—	$49 – $131
6	Devoted fee schedule · outpatient · +2 other terms	164	$52	$53	$3	6%	—	$48 – $68
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$58	$55	$5	10%	—	$50 – $70
8	Molina fee schedule · outpatient · +5 other terms	110	$72	$72	$27	37%	—	$42 – $135
9	Cigna fee schedule · outpatient · +6 other terms	95	$58	$66	$24	37%	—	$48 – $172
10	Anthem fee schedule · outpatient · +6 other terms	74	$50	$57	$11	19%	—	$48 – $118
11	Kaiser fee schedule · outpatient · +4 other terms	61	$51	$90	$73	82%	—	$48 – $444
12	Superior Healthplan fee schedule · outpatient	40	$54	$54	$0	0%	—	$51 – $54
13	Clover fee schedule · outpatient · +2 other terms	37	$66	$61	$5	8%	—	$54 – $67
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$106	$106	$27	25%	—	$49 – $141
15	Oscar fee schedule · outpatient · +3 other terms	32	$59	$60	$13	21%	—	$51 – $90
16	Optum fee schedule · outpatient · +3 other terms	26	$56	$62	$24	39%	—	$48 – $129
17	Caresource facility · case rate · outpatient · +4 other terms	20	$37	$56	$35	64%	—	$23 – $134
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$52	$53	$2	4%	—	$50 – $58
19	Bcbs Tx fee schedule · outpatient	18	$51	$51	—	—	—	$51 – $51
20	Medicare fee schedule · outpatient · +1 other terms	18	$48	$48	$0	1%	—	$48 – $49
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$68	$67	$1	2%	—	$64 – $68
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$59	$68	$17	25%	—	$32 – $93
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$53	$53	$12	23%	—	$26 – $63
24	Wellmark fee schedule · both · +1 other terms	13	$44	$45	$6	14%	—	$44 – $84
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$48	$51	$4	7%	—	$48 – $55

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