Trifocal eyeglass lens with specified power range

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 4.0/4.25

Payers reporting HCPCS V2305

Payer pricing summary

Low

$26

Average

$124

Median

$111

High

$309

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	336	$110	$109	$22	20%	—	$24 – $317
2	Aetna fee schedule · outpatient · +12 other terms	321	$110	$126	$64	51%	—	$49 – $640
3	Humana fee schedule · outpatient · +9 other terms	316	$110	$165	$172	105%	—	$76 – $839
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$112	$134	$86	64%	—	$0 – $506
5	WellCare fee schedule · outpatient · +4 other terms	202	$112	$115	$19	17%	—	$92 – $214
6	Devoted fee schedule · outpatient · +2 other terms	164	$109	$109	$5	4%	—	$95 – $130
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$113	$112	$6	5%	—	$101 – $131
8	Molina fee schedule · outpatient · +5 other terms	109	$139	$148	$57	38%	—	$84 – $286
9	Cigna fee schedule · outpatient · +6 other terms	95	$113	$124	$37	30%	—	$96 – $280
10	Anthem fee schedule · outpatient · +6 other terms	74	$101	$110	$16	15%	—	$93 – $191
11	Kaiser fee schedule · outpatient · +4 other terms	61	$103	$156	$111	71%	—	$96 – $702
12	Superior Healthplan fee schedule · outpatient	40	$115	$115	$1	0%	—	$107 – $115
13	Clover fee schedule · outpatient · +2 other terms	37	$110	$112	$4	4%	—	$107 – $127
14	Oscar fee schedule · outpatient · +3 other terms	32	$116	$121	$21	17%	—	$107 – $169
15	Ambetter facility · fee schedule · outpatient · +5 other terms	30	$172	$204	$54	27%	—	$108 – $275
16	Optum fee schedule · outpatient · +3 other terms	26	$110	$122	$53	43%	—	$92 – $273
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$79	$81	103%	—	$20 – $254
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$105	$100	$9	9%	—	$80 – $107
19	Bcbs Tx fee schedule · outpatient	18	$107	$107	—	—	—	$107 – $107
20	Medicare fee schedule · outpatient · +1 other terms	18	$97	$97	$1	1%	—	$97 – $99
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$132	$131	$3	2%	—	$126 – $132
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$95	$110	$27	25%	—	$52 – $151
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$87	$87	$20	23%	—	$42 – $102
24	Wellmark fee schedule · both · +1 other terms	13	$84	$86	$8	10%	—	$84 – $137
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$78	$90	$15	16%	—	$78 – $108

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