Single-vision lens with high sphere and cylinder power, 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

Spherocylinder 4.25d/2.12-4d

Payers reporting HCPCS V2108

Payer pricing summary

Low

$17

Average

$74

Median

$67

High

$198

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	336	$64	$63	$13	21%	—	$12 – $182
2	Aetna fee schedule · outpatient · +12 other terms	321	$65	$75	$39	53%	—	$26 – $410
3	Humana fee schedule · outpatient · +9 other terms	316	$67	$96	$103	107%	—	$44 – $501
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$64	$77	$53	69%	—	$0 – $308
5	WellCare fee schedule · outpatient · +4 other terms	202	$64	$67	$14	20%	—	$54 – $137
6	Devoted fee schedule · outpatient · +2 other terms	164	$65	$64	$4	6%	—	$55 – $75
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$65	$66	$3	5%	—	$58 – $76
8	Molina fee schedule · outpatient · +5 other terms	109	$79	$89	$34	39%	—	$54 – $171
9	Cigna fee schedule · outpatient · +6 other terms	95	$66	$73	$24	33%	—	$55 – $176
10	Anthem fee schedule · outpatient · +6 other terms	74	$68	$68	$10	14%	—	$54 – $116
11	Kaiser fee schedule · outpatient · +4 other terms	61	$71	$97	$62	64%	—	$55 – $403
12	Superior Healthplan fee schedule · outpatient	40	$68	$68	$0	0%	—	$64 – $68
13	Clover fee schedule · outpatient · +2 other terms	37	$69	$66	$4	6%	—	$58 – $73
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$105	$112	$25	22%	—	$54 – $146
15	Oscar fee schedule · outpatient · +3 other terms	32	$64	$71	$16	23%	—	$61 – $111
16	Optum fee schedule · outpatient · +3 other terms	26	$67	$74	$31	42%	—	$54 – $163
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$55	$41	76%	—	$20 – $146
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$72	$66	$10	16%	—	$46 – $74
19	Bcbs Tx fee schedule · outpatient	18	$64	$64	—	—	—	$64 – $64
20	Medicare fee schedule · outpatient · +1 other terms	18	$67	$67	$1	1%	—	$67 – $68
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$70	$69	$1	2%	—	$67 – $70
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$58	$67	$17	25%	—	$32 – $92
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$53	$53	$12	23%	—	$26 – $62
24	Wellmark fee schedule · both · +1 other terms	13	$48	$49	$6	11%	—	$48 – $83
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$47	$52	$5	9%	—	$47 – $57

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