Trifocal eyeglass lens, high-power sphere and cylinder

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 sphc trifocal 4.25-7/4.

Payers reporting HCPCS V2309

Payer pricing summary

Low

$33

Average

$138

Median

$123

High

$314

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	336	$117	$121	$26	22%	—	$52 – $380
2	Aetna fee schedule · outpatient · +11 other terms	321	$127	$141	$75	53%	—	$56 – $812
3	Humana fee schedule · outpatient · +9 other terms	316	$127	$179	$181	101%	—	$84 – $880
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$130	$152	$98	64%	—	$0 – $566
5	WellCare fee schedule · outpatient · +4 other terms	202	$118	$124	$19	16%	—	$103 – $218
6	Devoted fee schedule · outpatient · +2 other terms	164	$114	$117	$8	7%	—	$102 – $144
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$131	$120	$10	8%	—	$106 – $146
8	Molina fee schedule · outpatient · +5 other terms	109	$150	$158	$59	37%	—	$88 – $300
9	Cigna fee schedule · outpatient · +7 other terms	95	$131	$137	$40	29%	—	$102 – $313
10	Anthem fee schedule · outpatient · +6 other terms	74	$106	$121	$22	18%	—	$102 – $213
11	Kaiser fee schedule · outpatient · +4 other terms	61	$108	$182	$138	76%	—	$102 – $840
12	Superior Healthplan fee schedule · outpatient	40	$120	$120	$1	0%	—	$112 – $120
13	Clover fee schedule · outpatient · +2 other terms	37	$120	$120	$10	9%	—	$110 – $141
14	Ambetter facility · fee schedule · outpatient · +5 other terms	32	$192	$235	$61	26%	—	$125 – $318
15	Oscar fee schedule · outpatient · +4 other terms	32	$133	$136	$33	24%	—	$112 – $216
16	Optum fee schedule · outpatient · +4 other terms	26	$121	$132	$55	41%	—	$102 – $286
17	Caresource facility · case rate · outpatient · +4 other terms	20	$59	$105	$82	78%	—	$36 – $283
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$110	$109	$4	4%	—	$95 – $112
19	Bcbs Tx fee schedule · outpatient	18	$112	$112	—	—	—	$112 – $112
20	Medicare fee schedule · outpatient · +1 other terms	18	$102	$102	$1	1%	—	$102 – $104
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$152	$151	$3	2%	—	$145 – $152
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$107	$124	$31	25%	—	$58 – $169
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$97	$97	$23	23%	—	$47 – $114
24	Wellmark fee schedule · both · +1 other terms	13	$94	$95	$10	10%	—	$94 – $153
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$87	$103	$18	18%	—	$87 – $125

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