Bifocal eyeglass lens, plano to ±4.00 sphere, 4.25 to 6.00 cylinder

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/4.2

Payers reporting HCPCS V2205

Payer pricing summary

Low

$20

Average

$94

Median

$82

High

$266

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	337	$77	$80	$18	23%	—	$16 – $264
2	Aetna fee schedule · outpatient · +12 other terms	321	$77	$95	$52	55%	—	$33 – $532
3	Humana fee schedule · outpatient · +9 other terms	316	$78	$117	$119	102%	—	$57 – $581
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$77	$99	$71	72%	—	$0 – $400
5	WellCare fee schedule · outpatient · +4 other terms	202	$78	$82	$19	24%	—	$73 – $184
6	Devoted fee schedule · outpatient · +2 other terms	164	$76	$76	$2	3%	—	$72 – $97
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$81	$79	$6	8%	—	$75 – $99
8	Molina fee schedule · outpatient · +5 other terms	110	$102	$105	$39	37%	—	$64 – $198
9	Cigna fee schedule · outpatient · +6 other terms	95	$79	$93	$32	35%	—	$73 – $236
10	Anthem fee schedule · outpatient · +6 other terms	74	$80	$85	$12	15%	—	$74 – $151
11	Kaiser fee schedule · outpatient · +4 other terms	61	$83	$128	$93	73%	—	$78 – $584
12	Superior Healthplan fee schedule · outpatient	40	$79	$79	$0	0%	—	$74 – $79
13	Clover fee schedule · outpatient · +2 other terms	37	$93	$85	$7	8%	—	$75 – $95
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$136	$144	$33	23%	—	$74 – $188
15	Oscar fee schedule · outpatient · +3 other terms	32	$79	$86	$19	22%	—	$74 – $133
16	Optum fee schedule · outpatient · +3 other terms	26	$78	$90	$35	38%	—	$70 – $189
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$64	$58	90%	—	$20 – $191
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$85	$81	$6	7%	—	$66 – $86
19	Bcbs Tx fee schedule · outpatient	18	$74	$74	—	—	—	$74 – $74
20	Medicare fee schedule · outpatient · +1 other terms	18	$78	$78	$1	1%	—	$78 – $80
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$90	$90	$2	2%	—	$86 – $90
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$75	$87	$22	25%	—	$41 – $119
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$68	$68	$16	23%	—	$33 – $80
24	Wellmark fee schedule · both · +1 other terms	13	$63	$64	$7	11%	—	$63 – $108
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$62	$67	$6	9%	—	$62 – $74

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