Bifocal lens, plano to ±4.00 diopters, 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 spher bifoc plano 4.00d

Payers reporting HCPCS V2200

Payer pricing summary

Low

$19

Average

$83

Median

$73

High

$235

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	337	$67	$66	$21	31%	—	$13 – $259
2	Aetna fee schedule · outpatient · +12 other terms	321	$71	$85	$49	58%	—	$28 – $522
3	Humana fee schedule · outpatient · +11 other terms	316	$67	$106	$115	109%	—	$50 – $558
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$71	$88	$62	70%	—	$0 – $349
5	WellCare fee schedule · outpatient · +4 other terms	202	$71	$75	$17	23%	—	$62 – $163
6	Devoted fee schedule · outpatient · +2 other terms	164	$66	$70	$4	6%	—	$63 – $85
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$67	$72	$5	6%	—	$63 – $86
8	Molina fee schedule · outpatient · +5 other terms	110	$87	$99	$38	38%	—	$56 – $190
9	Cigna fee schedule · outpatient · +7 other terms	95	$66	$81	$28	35%	—	$62 – $209
10	Anthem fee schedule · outpatient · +7 other terms	74	$67	$72	$12	16%	—	$62 – $128
11	Kaiser fee schedule · outpatient · +4 other terms	61	$69	$118	$94	80%	—	$65 – $573
12	Superior Healthplan fee schedule · outpatient	40	$76	$76	$0	0%	—	$71 – $76
13	Clover fee schedule · outpatient · +2 other terms	37	$82	$75	$8	10%	—	$63 – $84
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$115	$123	$25	20%	—	$62 – $157
15	Oscar fee schedule · outpatient · +3 other terms	32	$71	$78	$18	23%	—	$66 – $122
16	Optum fee schedule · outpatient · +3 other terms	26	$65	$79	$36	46%	—	$62 – $181
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$59	$49	83%	—	$20 – $167
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$70	$70	$2	3%	—	$65 – $75
19	Bcbs Tx fee schedule · outpatient	18	$71	$71	—	—	—	$71 – $71
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	$75	$75	$1	2%	—	$72 – $75
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$64	$74	$18	25%	—	$35 – $101
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$58	$58	$14	23%	—	$28 – $68
24	Wellmark fee schedule · both · +1 other terms	13	$57	$58	$6	10%	—	$57 – $92
25	Aetna Better Health fee schedule · outpatient · +4 other terms	12	$52	$56	$5	8%	—	$52 – $62

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