Single-vision eyeglass lens with high prescription power

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/4.25-6d

Payers reporting HCPCS V2109

Payer pricing summary

Low

$19

Average

$84

Median

$72

High

$220

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	336	$67	$69	$16	23%	—	$13 – $223
2	Aetna fee schedule · outpatient · +12 other terms	321	$68	$81	$46	57%	—	$30 – $473
3	Humana fee schedule · outpatient · +9 other terms	316	$69	$99	$98	100%	—	$48 – $481
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$68	$89	$74	84%	—	$0 – $429
5	WellCare fee schedule · outpatient · +4 other terms	202	$66	$69	$16	23%	—	$60 – $153
6	Devoted fee schedule · outpatient · +2 other terms	164	$63	$64	$3	5%	—	$58 – $83
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$69	$66	$6	9%	—	$61 – $84
8	Molina fee schedule · outpatient · +5 other terms	109	$86	$88	$32	36%	—	$51 – $164
9	Cigna fee schedule · outpatient · +6 other terms	95	$69	$79	$31	39%	—	$58 – $238
10	Anthem fee schedule · outpatient · +6 other terms	74	$61	$70	$15	22%	—	$58 – $162
11	Kaiser fee schedule · outpatient · +4 other terms	61	$62	$106	$81	77%	—	$58 – $494
12	Superior Healthplan fee schedule · outpatient	40	$66	$66	$0	0%	—	$61 – $66
13	Clover fee schedule · outpatient · +2 other terms	37	$77	$72	$5	7%	—	$66 – $81
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$146	$133	$30	22%	—	$60 – $168
15	Oscar fee schedule · outpatient · +3 other terms	32	$71	$74	$20	27%	—	$61 – $124
16	Optum fee schedule · outpatient · +3 other terms	26	$67	$75	$29	39%	—	$58 – $156
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$58	$47	81%	—	$20 – $162
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$63	$63	$2	3%	—	$56 – $64
19	Bcbs Tx fee schedule · outpatient	18	$61	$61	—	—	—	$61 – $61
20	Medicare fee schedule · outpatient · +1 other terms	18	$58	$59	$0	1%	—	$58 – $60
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$81	$80	$2	2%	—	$77 – $81
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$81	$93	$23	25%	—	$44 – $128
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$74	$74	$17	23%	—	$36 – $86
24	Wellmark fee schedule · both · +1 other terms	13	$54	$55	$10	18%	—	$54 – $116
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$66	$66	$0	0%	—	$66 – $66

Page 1 of 3 · 52 payers