Bifocal eyeglass lens, custom power, 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 sphcy bifocal 4.25-7/4.

Payers reporting HCPCS V2209

Payer pricing summary

Low

$23

Average

$103

Median

$89

High

$260

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	336	$85	$88	$19	22%	—	$23 – $281
2	Aetna fee schedule · outpatient · +12 other terms	321	$86	$103	$57	55%	—	$38 – $567
3	Humana fee schedule · outpatient · +9 other terms	316	$88	$126	$124	99%	—	$63 – $608
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$87	$110	$80	72%	—	$0 – $457
5	WellCare fee schedule · outpatient · +4 other terms	202	$87	$87	$18	20%	—	$78 – $180
6	Devoted fee schedule · outpatient · +2 other terms	164	$84	$82	$4	5%	—	$79 – $107
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$88	$84	$8	10%	—	$79 – $109
8	Molina fee schedule · outpatient · +5 other terms	109	$111	$111	$41	37%	—	$71 – $207
9	Cigna fee schedule · outpatient · +6 other terms	95	$88	$102	$34	34%	—	$78 – $253
10	Anthem fee schedule · outpatient · +6 other terms	74	$85	$92	$15	16%	—	$82 – $172
11	Kaiser fee schedule · outpatient · +4 other terms	61	$87	$137	$100	73%	—	$82 – $622
12	Superior Healthplan fee schedule · outpatient	40	$83	$83	$0	0%	—	$78 – $83
13	Clover fee schedule · outpatient · +2 other terms	37	$90	$89	$4	5%	—	$83 – $105
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$155	$163	$37	23%	—	$84 – $213
15	Oscar fee schedule · outpatient · +3 other terms	32	$90	$94	$23	25%	—	$77 – $150
16	Optum fee schedule · outpatient · +3 other terms	26	$85	$98	$35	36%	—	$79 – $198
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$69	$65	94%	—	$20 – $211
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$89	$86	$6	7%	—	$71 – $91
19	Bcbs Tx fee schedule · outpatient	18	$78	$78	—	—	—	$78 – $78
20	Medicare fee schedule · outpatient · +1 other terms	18	$82	$82	$1	1%	—	$82 – $84
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$102	$101	$2	2%	—	$97 – $102
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$86	$99	$25	25%	—	$47 – $136
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$78	$78	$18	23%	—	$38 – $92
24	Wellmark fee schedule · both · +1 other terms	13	$78	$79	$7	9%	—	$78 – $124
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$70	$76	$6	9%	—	$70 – $84

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