Toric or prism ballast contact 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

Cntct lens pmma-toric/prism

Payers reporting HCPCS V2501

Payer pricing summary

Low

$44

Average

$199

Median

$180

High

$569

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	337	$155	$165	$37	22%	—	$74 – $503
2	Aetna fee schedule · outpatient · +10 other terms	321	$157	$199	$110	55%	—	$67 – $1.2k
3	Humana fee schedule · outpatient · +9 other terms	316	$178	$239	$238	100%	—	$120 – $1.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	212	$155	$215	$157	73%	—	$0 – $848
5	WellCare fee schedule · outpatient · +4 other terms	202	$156	$169	$44	26%	—	$149 – $394
6	Devoted fee schedule · outpatient · +2 other terms	164	$152	$157	$12	8%	—	$152 – $206
7	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$162	$159	$13	8%	—	$152 – $208
8	Molina fee schedule · outpatient · +5 other terms	110	$201	$211	$80	38%	—	$128 – $397
9	Cigna fee schedule · outpatient · +6 other terms	95	$182	$192	$61	32%	—	$149 – $505
10	Anthem fee schedule · outpatient · +6 other terms	74	$182	$184	$26	14%	—	$149 – $320
11	Kaiser fee schedule · outpatient · +4 other terms	61	$189	$263	$172	65%	—	$152 – $1.1k
12	Superior Healthplan fee schedule · outpatient	40	$159	$159	$1	0%	—	$149 – $159
13	Ambetter facility · fee schedule · outpatient · +5 other terms	39	$288	$299	$56	19%	—	$149 – $426
14	Clover fee schedule · outpatient · +2 other terms	37	$198	$177	$20	12%	—	$152 – $202
15	Oscar fee schedule · outpatient · +3 other terms	32	$159	$177	$47	26%	—	$149 – $288
16	Optum fee schedule · outpatient · +3 other terms	26	$178	$193	$66	34%	—	$152 – $379
17	Caresource facility · case rate · outpatient · +4 other terms	20	$59	$130	$125	96%	—	$36 – $404
18	Regence facility · fee schedule · outpatient · +1 other terms	19	$193	$178	$25	14%	—	$126 – $196
19	Bcbs Tx fee schedule · outpatient	18	$149	$149	—	—	—	$149 – $149
20	Medicare fee schedule · outpatient · +1 other terms	18	$178	$179	$1	1%	—	$178 – $182
21	Amerihealth Caritas fee schedule · outpatient	16	$182	$180	$4	2%	—	$173 – $182
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$160	$185	$46	25%	—	$87 – $253
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$145	$145	$34	23%	—	$71 – $170
24	Tricare facility · fee schedule · outpatient · +2 other terms	13	$180	$181	$12	7%	—	$149 – $202
25	Wellmark fee schedule · both · +1 other terms	13	$178	$180	$8	5%	—	$178 – $230

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