Trifocal eyeglass lens, 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 trifocal 4.0/.12-

Payers reporting HCPCS V2303

Payer pricing summary

Low

$20

Average

$105

Median

$93

High

$277

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	337	$88	$88	$20	23%	—	$22 – $305
2	Aetna fee schedule · outpatient · +12 other terms	322	$88	$105	$58	55%	—	$38 – $614
3	Humana fee schedule · outpatient · +9 other terms	316	$88	$134	$143	106%	—	$62 – $692
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$89	$112	$77	68%	—	$0 – $447
5	WellCare fee schedule · outpatient · +4 other terms	202	$90	$95	$18	20%	—	$80 – $192
6	Devoted fee schedule · outpatient · +2 other terms	164	$86	$89	$4	4%	—	$79 – $107
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$92	$90	$3	3%	—	$84 – $108
8	Molina fee schedule · outpatient · +5 other terms	109	$116	$123	$47	38%	—	$70 – $236
9	Cigna fee schedule · outpatient · +7 other terms	95	$88	$100	$30	30%	—	$80 – $248
10	Anthem fee schedule · outpatient · +7 other terms	74	$84	$89	$14	16%	—	$81 – $169
11	Kaiser fee schedule · outpatient · +4 other terms	61	$86	$144	$110	77%	—	$81 – $674
12	Superior Healthplan fee schedule · outpatient	40	$94	$94	$0	0%	—	$88 – $94
13	Clover fee schedule · outpatient · +2 other terms	37	$97	$94	$4	4%	—	$86 – $105
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$152	$165	$36	22%	—	$84 – $214
15	Oscar fee schedule · outpatient · +3 other terms	32	$90	$101	$25	25%	—	$88 – $163
16	Optum fee schedule · outpatient · +3 other terms	26	$86	$99	$44	44%	—	$77 – $225
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$69	$65	94%	—	$20 – $210
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$88	$87	$3	4%	—	$77 – $89
19	Bcbs Tx fee schedule · outpatient	18	$88	$88	—	—	—	$88 – $88
20	Medicare fee schedule · outpatient · +1 other terms	18	$81	$81	$1	1%	—	$81 – $83
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$103	$102	$2	2%	—	$98 – $103
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$84	$97	$24	25%	—	$46 – $133
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$77	$77	$18	23%	—	$37 – $90
24	Wellmark fee schedule · both · +1 other terms	13	$69	$71	$8	12%	—	$69 – $121
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$69	$75	$7	10%	—	$69 – $84

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