Lenticular lens, single vision (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

Lens lenticular bifocal

Payers reporting HCPCS V2115

Payer pricing summary

Low

$30

Average

$124

Median

$113

High

$266

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	336	$104	$102	$26	25%	—	$26 – $357
2	Aetna fee schedule · outpatient · +10 other terms	321	$106	$124	$71	57%	—	$40 – $763
3	Humana fee schedule · outpatient · +9 other terms	316	$104	$166	$195	117%	—	$72 – $929
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$118	$133	$98	74%	—	$0 – $573
5	WellCare fee schedule · outpatient · +4 other terms	202	$111	$117	$19	16%	—	$89 – $182
6	Devoted fee schedule · outpatient · +2 other terms	164	$106	$112	$13	12%	—	$91 – $128
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$102	$113	$11	10%	—	$91 – $124
8	Molina fee schedule · outpatient · +5 other terms	109	$141	$160	$65	41%	—	$89 – $316
9	Cigna fee schedule · outpatient · +6 other terms	95	$106	$115	$35	30%	—	$89 – $317
10	Anthem fee schedule · outpatient · +6 other terms	74	$106	$108	$21	20%	—	$89 – $226
11	Kaiser fee schedule · outpatient · +4 other terms	61	$110	$174	$127	73%	—	$104 – $789
12	Superior Healthplan fee schedule · outpatient	40	$127	$127	$1	0%	—	$118 – $127
13	Clover fee schedule · outpatient · +2 other terms	37	$94	$100	$14	14%	—	$91 – $127
14	Oscar fee schedule · outpatient · +3 other terms	32	$118	$124	$33	26%	—	$95 – $197
15	Ambetter facility · fee schedule · outpatient · +5 other terms	30	$195	$187	$34	18%	—	$89 – $226
16	Optum fee schedule · outpatient · +3 other terms	26	$104	$121	$63	52%	—	$89 – $302
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$75	$76	101%	—	$20 – $242
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$112	$109	$7	7%	—	$90 – $114
19	Bcbs Tx fee schedule · outpatient	18	$118	$118	—	—	—	$118 – $118
20	Medicare fee schedule · outpatient · +1 other terms	18	$104	$104	$1	1%	—	$104 – $106
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$109	$108	$2	2%	—	$103 – $109
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$108	$124	$31	25%	—	$59 – $171
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$98	$98	$23	23%	—	$48 – $115
24	Wellmark fee schedule · both · +1 other terms	13	$80	$82	$12	15%	—	$80 – $155
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$88	$88	$0	0%	—	$88 – $89

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