Polymethyl methacrylate spherical contact 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

Contact lens pmma spherical

Payers reporting HCPCS V2500

Payer pricing summary

Low

$28

Average

$137

Median

$122

High

$373

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	337	$109	$114	$30	26%	—	$49 – $440
2	Aetna fee schedule · outpatient · +10 other terms	321	$114	$138	$81	59%	—	$44 – $887
3	Humana fee schedule · outpatient · +9 other terms	316	$110	$176	$199	113%	—	$79 – $957
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	204	$115	$129	$74	57%	—	$0 – $599
5	WellCare fee schedule · outpatient · +4 other terms	202	$122	$125	$27	22%	—	$98 – $259
6	Devoted fee schedule · outpatient · +2 other terms	164	$104	$117	$11	10%	—	$100 – $135
7	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$106	$120	$10	8%	—	$100 – $138
8	Molina fee schedule · outpatient · +5 other terms	110	$142	$168	$65	39%	—	$88 – $326
9	Cigna fee schedule · outpatient · +6 other terms	95	$105	$132	$49	37%	—	$98 – $332
10	Anthem fee schedule · outpatient · +6 other terms	74	$105	$114	$20	18%	—	$98 – $225
11	Kaiser fee schedule · outpatient · +4 other terms	61	$107	$192	$162	84%	—	$101 – $974
12	Ambetter facility · fee schedule · outpatient · +5 other terms	41	$192	$196	$37	19%	—	$98 – $249
13	Superior Healthplan fee schedule · outpatient	40	$131	$131	$1	0%	—	$122 – $131
14	Clover fee schedule · outpatient · +2 other terms	37	$130	$122	$13	11%	—	$100 – $133
15	Oscar fee schedule · outpatient · +3 other terms	32	$122	$128	$26	20%	—	$104 – $183
16	Optum fee schedule · outpatient · +3 other terms	26	$101	$128	$64	50%	—	$100 – $311
17	Caresource facility · case rate · outpatient · +4 other terms	20	$32	$81	$85	105%	—	$20 – $265
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$109	$113	$6	6%	—	$105 – $127
19	Bcbs Tx fee schedule · outpatient	18	$122	$122	—	—	—	$122 – $122
20	Medicare fee schedule · outpatient · +1 other terms	18	$101	$102	$1	1%	—	$101 – $103
21	Amerihealth Caritas fee schedule · outpatient	16	$119	$118	$2	2%	—	$113 – $119
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$113	$130	$32	25%	—	$61 – $178
23	Tricare facility · fee schedule · outpatient · +2 other terms	14	$133	$125	$13	10%	—	$98 – $133
24	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$102	$102	$24	23%	—	$50 – $120
25	Wellmark fee schedule · both · +1 other terms	13	$91	$93	$11	12%	—	$91 – $162

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