Ocular conformer fabrication and fitting

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

IMPLANT MEDPOR ORBITAL 3D RT LG

Payers reporting HCPCS V2628

Payer pricing summary

Low

$97

Average

$440

Median

$441

High

$1.0k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +15 other terms	360	$416	$389	$149	38%	—	$10 – $1.6k
2	Aetna fee schedule · outpatient · +13 other terms	327	$452	$515	$279	54%	—	$79 – $3.3k
3	Humana fee schedule · outpatient · +14 other terms	326	$417	$654	$729	112%	—	$26 – $3.5k
4	Blue Cross Blue Shield fee schedule · outpatient · +16 other terms	217	$452	$567	$370	65%	—	$0 – $2.2k
5	WellCare fee schedule · outpatient · +6 other terms	203	$475	$468	$63	13%	—	$359 – $738
6	Devoted fee schedule · outpatient · +5 other terms	164	$461	$454	$29	6%	—	$401 – $506
7	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$429	$452	$26	6%	—	$387 – $511
8	Molina fee schedule · outpatient · +10 other terms	114	$511	$617	$245	40%	—	$359 – $1.2k
9	Cigna fee schedule · outpatient · +12 other terms	95	$477	$496	$120	24%	—	$384 – $1.1k
10	Anthem fee schedule · outpatient · +11 other terms	76	$477	$383	$131	34%	—	$30 – $745
11	Kaiser fee schedule · outpatient · +6 other terms	61	$507	$761	$581	76%	—	$428 – $3.6k
12	Ambetter facility · fee schedule · outpatient · +7 other terms	41	$670	$679	$212	31%	—	$100 – $1.0k
13	Superior Healthplan fee schedule · outpatient	40	$484	$484	$2	0%	—	$452 – $484
14	Clover fee schedule · outpatient · +2 other terms	37	$401	$412	$44	11%	—	$371 – $497
15	Oscar fee schedule · outpatient · +5 other terms	33	$452	$495	$100	20%	—	$421 – $844
16	Medica fee schedule · outpatient · +5 other terms	30	$552	$478	$353	74%	—	$26 – $998
17	Optum fee schedule · outpatient · +6 other terms	26	$477	$513	$226	44%	—	$359 – $1.2k
18	Caresource facility · case rate · outpatient · +6 other terms	20	$92	$284	$330	116%	—	$56 – $993
19	MultiPlan fee schedule · outpatient · +10 other terms	19	$143	$156	$85	54%	—	$62 – $452
20	Regence facility · fee schedule · outpatient · +6 other terms	19	$517	$500	$33	7%	—	$414 – $526
21	Bcbs Tx fee schedule · outpatient	18	$452	$452	—	—	—	$452 – $452
22	Medicare fee schedule · outpatient · +3 other terms	18	$477	$479	$4	1%	—	$477 – $487
23	Amerihealth Caritas fee schedule · outpatient · +3 other terms	16	$481	$477	$9	2%	—	$457 – $481
24	Medical Mutual facility · fee schedule · outpatient · +3 other terms	15	$372	$450	$103	23%	—	$203 – $589
25	Sanford Health Plan fee schedule · outpatient · +6 other terms	14	$359	$412	$153	37%	—	$73 – $644

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