Bifocal eyeglass lens with sphere and cylinder correction

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 sphcy bifocal 4.00d/2.1

Payers reporting HCPCS V2204

Payer pricing summary

Low

$21

Average

$87

Median

$77

High

$244

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	337	$71	$74	$17	23%	—	$15 – $255
2	Aetna fee schedule · outpatient · +12 other terms	321	$71	$88	$50	57%	—	$30 – $514
3	Humana fee schedule · outpatient · +9 other terms	316	$71	$110	$115	105%	—	$52 – $557
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$71	$92	$65	70%	—	$0 – $360
5	WellCare fee schedule · outpatient · +4 other terms	202	$72	$77	$17	23%	—	$66 – $169
6	Devoted fee schedule · outpatient · +2 other terms	164	$70	$72	$3	4%	—	$67 – $90
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$73	$74	$5	7%	—	$69 – $92
8	Molina fee schedule · outpatient · +5 other terms	110	$94	$100	$38	38%	—	$58 – $190
9	Cigna fee schedule · outpatient · +6 other terms	95	$71	$85	$30	35%	—	$67 – $217
10	Anthem fee schedule · outpatient · +6 other terms	74	$70	$76	$13	17%	—	$67 – $136
11	Kaiser fee schedule · outpatient · +4 other terms	61	$71	$120	$92	77%	—	$67 – $565
12	Superior Healthplan fee schedule · outpatient	40	$76	$76	$0	0%	—	$71 – $76
13	Clover fee schedule · outpatient · +2 other terms	37	$85	$79	$6	8%	—	$69 – $88
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$122	$133	$28	21%	—	$67 – $172
15	Oscar fee schedule · outpatient · +3 other terms	32	$72	$82	$21	26%	—	$71 – $135
16	Optum fee schedule · outpatient · +3 other terms	26	$69	$82	$35	42%	—	$65 – $181
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$61	$52	86%	—	$20 – $177
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$73	$72	$2	3%	—	$64 – $74
19	Bcbs Tx fee schedule · outpatient	18	$71	$71	—	—	—	$71 – $71
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	$82	$82	$2	2%	—	$78 – $82
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$68	$79	$19	25%	—	$37 – $107
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$62	$62	$14	23%	—	$30 – $72
24	Wellmark fee schedule · both · +1 other terms	13	$59	$60	$6	10%	—	$59 – $98
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$55	$60	$6	10%	—	$55 – $67

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