Trifocal spectacle lens, high power, 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 sphc trifo 7.25-12/4.25

Payers reporting HCPCS V2313

Payer pricing summary

Low

$42

Average

$160

Median

$146

High

$349

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	336	$132	$141	$33	23%	—	$60 – $418
2	Aetna fee schedule · outpatient · +10 other terms	321	$133	$164	$90	55%	—	$71 – $1.2k
3	Humana fee schedule · outpatient · +9 other terms	316	$157	$209	$205	98%	—	$96 – $996
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	211	$163	$181	$118	65%	—	$0 – $683
5	WellCare fee schedule · outpatient · +4 other terms	202	$133	$144	$24	16%	—	$122 – $242
6	Devoted fee schedule · outpatient · +2 other terms	164	$129	$136	$15	11%	—	$118 – $168
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$133	$139	$17	13%	—	$123 – $173
8	Molina fee schedule · outpatient · +5 other terms	109	$173	$179	$67	38%	—	$102 – $339
9	Cigna fee schedule · outpatient · +6 other terms	95	$160	$158	$41	26%	—	$118 – $377
10	Anthem fee schedule · outpatient · +7 other terms	75	$126	$131	$35	27%	—	$54 – $266
11	Kaiser fee schedule · outpatient · +4 other terms	61	$125	$209	$154	73%	—	$118 – $925
12	Superior Healthplan fee schedule · outpatient	40	$136	$136	$1	0%	—	$127 – $136
13	Clover fee schedule · outpatient · +2 other terms	37	$136	$140	$20	14%	—	$122 – $168
14	Oscar fee schedule · outpatient · +3 other terms	32	$168	$163	$47	29%	—	$127 – $278
15	Ambetter facility · fee schedule · outpatient · +5 other terms	30	$232	$295	$80	27%	—	$155 – $400
16	Optum fee schedule · outpatient · +3 other terms	26	$128	$153	$61	40%	—	$118 – $324
17	Caresource facility · case rate · outpatient · +4 other terms	20	$59	$115	$99	86%	—	$36 – $327
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$127	$124	$7	6%	—	$105 – $130
19	Bcbs Tx fee schedule · outpatient	18	$127	$127	—	—	—	$127 – $127
20	Medicare fee schedule · outpatient · +1 other terms	18	$118	$118	$1	1%	—	$118 – $120
21	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$192	$190	$4	2%	—	$183 – $192
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$129	$149	$37	25%	—	$70 – $203
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$117	$117	$27	23%	—	$57 – $137
24	Wellmark fee schedule · both · +1 other terms	13	$108	$110	$12	11%	—	$108 – $185
25	Aetna Better Health fee schedule · outpatient · +3 other terms	12	$105	$127	$26	20%	—	$105 – $157

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