Trifocal 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 sphere trifocal 4.00d

Payers reporting HCPCS V2300

Payer pricing summary

Low

$23

Average

$107

Median

$94

High

$290

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	336	$88	$90	$21	23%	—	$20 – $307
2	Aetna fee schedule · outpatient · +12 other terms	321	$90	$107	$59	55%	—	$36 – $618
3	Humana fee schedule · outpatient · +9 other terms	316	$88	$137	$151	110%	—	$63 – $728
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$93	$113	$80	71%	—	$0 – $465
5	WellCare fee schedule · outpatient · +4 other terms	202	$93	$97	$20	21%	—	$80 – $201
6	Devoted fee schedule · outpatient · +2 other terms	164	$87	$91	$6	7%	—	$80 – $109
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$88	$93	$5	5%	—	$82 – $110
8	Molina fee schedule · outpatient · +5 other terms	109	$109	$128	$50	39%	—	$74 – $248
9	Cigna fee schedule · outpatient · +6 other terms	95	$87	$102	$34	33%	—	$80 – $258
10	Anthem fee schedule · outpatient · +6 other terms	74	$88	$92	$14	15%	—	$80 – $175
11	Kaiser fee schedule · outpatient · +4 other terms	61	$90	$145	$109	76%	—	$85 – $678
12	Superior Healthplan fee schedule · outpatient	40	$99	$99	$0	0%	—	$93 – $99
13	Clover fee schedule · outpatient · +2 other terms	37	$101	$96	$8	8%	—	$82 – $107
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$158	$160	$33	21%	—	$80 – $204
15	Oscar fee schedule · outpatient · +3 other terms	32	$93	$101	$22	21%	—	$86 – $151
16	Optum fee schedule · outpatient · +3 other terms	26	$85	$102	$47	46%	—	$78 – $237
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$69	$66	95%	—	$20 – $213
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$92	$90	$5	5%	—	$77 – $94
19	Bcbs Tx fee schedule · outpatient	18	$93	$93	—	—	—	$93 – $93
20	Medicare fee schedule · outpatient · +1 other terms	18	$85	$85	$1	1%	—	$85 – $87
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$98	$97	$2	2%	—	$93 – $98
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$88	$101	$25	25%	—	$48 – $138
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$80	$80	$19	23%	—	$39 – $93
24	Wellmark fee schedule · both · +1 other terms	13	$70	$72	$9	12%	—	$70 – $126
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$72	$75	$4	5%	—	$72 – $80

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