Trifocal spectacle lens, sphere power ±4.12 to ±7.00 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 4.12-7.

Payers reporting HCPCS V2301

Payer pricing summary

Low

$33

Average

$125

Median

$115

High

$281

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	337	$99	$105	$24	23%	—	$23 – $322
2	Aetna fee schedule · outpatient · +12 other terms	322	$104	$125	$68	55%	—	$42 – $691
3	Humana fee schedule · outpatient · +9 other terms	316	$98	$171	$200	117%	—	$75 – $954
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$122	$137	$97	71%	—	$0 – $570
5	WellCare fee schedule · outpatient · +4 other terms	202	$104	$120	$20	17%	—	$93 – $195
6	Devoted fee schedule · outpatient · +2 other terms	164	$95	$114	$15	13%	—	$90 – $131
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$101	$116	$12	10%	—	$94 – $129
8	Molina fee schedule · outpatient · +5 other terms	109	$135	$163	$66	41%	—	$78 – $325
9	Cigna fee schedule · outpatient · +7 other terms	95	$99	$117	$39	33%	—	$90 – $315
10	Anthem fee schedule · outpatient · +7 other terms	74	$94	$106	$20	19%	—	$90 – $215
11	Kaiser fee schedule · outpatient · +4 other terms	61	$96	$157	$116	74%	—	$90 – $713
12	Superior Healthplan fee schedule · outpatient	40	$130	$130	$1	0%	—	$122 – $130
13	Clover fee schedule · outpatient · +2 other terms	37	$98	$105	$13	13%	—	$95 – $130
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$193	$192	$36	19%	—	$93 – $254
15	Oscar fee schedule · outpatient · +3 other terms	32	$121	$126	$28	23%	—	$99 – $186
16	Optum fee schedule · outpatient · +3 other terms	26	$95	$120	$66	55%	—	$90 – $310
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$77	$80	103%	—	$20 – $251
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$98	$96	$5	5%	—	$81 – $100
19	Bcbs Tx fee schedule · outpatient	18	$122	$122	—	—	—	$122 – $122
20	Medicare fee schedule · outpatient · +1 other terms	18	$90	$91	$1	1%	—	$90 – $92
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$113	$112	$2	2%	—	$108 – $113
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$107	$124	$31	25%	—	$59 – $170
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$98	$98	$23	23%	—	$48 – $114
24	Wellmark fee schedule · both · +1 other terms	13	$83	$85	$11	13%	—	$83 – $154
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$88	$90	$2	3%	—	$88 – $93

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