Trifocal spherocylinder 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 4.0/2.25

Payers reporting HCPCS V2304

Payer pricing summary

Low

$26

Average

$108

Median

$96

High

$299

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	336	$90	$92	$19	21%	—	$23 – $282
2	Aetna fee schedule · outpatient · +12 other terms	321	$91	$109	$58	54%	—	$40 – $618
3	Humana fee schedule · outpatient · +9 other terms	316	$90	$136	$139	102%	—	$65 – $676
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$92	$114	$78	69%	—	$0 – $453
5	WellCare fee schedule · outpatient · +4 other terms	202	$91	$95	$21	22%	—	$82 – $207
6	Devoted fee schedule · outpatient · +2 other terms	164	$90	$89	$3	3%	—	$82 – $112
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$92	$91	$6	6%	—	$88 – $113
8	Molina fee schedule · outpatient · +5 other terms	109	$113	$121	$46	38%	—	$75 – $230
9	Cigna fee schedule · outpatient · +6 other terms	95	$92	$105	$34	32%	—	$84 – $266
10	Anthem fee schedule · outpatient · +6 other terms	74	$90	$96	$14	15%	—	$84 – $171
11	Kaiser fee schedule · outpatient · +4 other terms	61	$92	$142	$100	70%	—	$85 – $623
12	Superior Healthplan fee schedule · outpatient	40	$92	$92	$0	0%	—	$86 – $92
13	Clover fee schedule · outpatient · +2 other terms	37	$104	$98	$6	6%	—	$90 – $110
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$154	$171	$38	22%	—	$88 – $224
15	Oscar fee schedule · outpatient · +3 other terms	32	$94	$102	$27	26%	—	$86 – $169
16	Optum fee schedule · outpatient · +3 other terms	26	$89	$103	$41	39%	—	$81 – $220
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$71	$68	96%	—	$20 – $219
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$94	$89	$8	9%	—	$71 – $96
19	Bcbs Tx fee schedule · outpatient	18	$86	$86	—	—	—	$86 – $86
20	Medicare fee schedule · outpatient · +1 other terms	18	$87	$87	$1	1%	—	$87 – $89
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$108	$107	$2	2%	—	$102 – $108
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$85	$99	$24	25%	—	$46 – $135
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$78	$78	$18	23%	—	$38 – $91
24	Wellmark fee schedule · both · +1 other terms	13	$73	$74	$8	11%	—	$73 – $123
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$70	$77	$9	12%	—	$70 – $88

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