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.
Original text from hospital filings
Lenticular lens, single
Devils Lake, ND
See all hospitals reporting HCPCS V2121 →Price type
Altru Hospital Devils Lake’s median price of $104 is about the same as the median hospital's median price ($104), higher than 48% of the 723 hospitals reporting HCPCS V2121. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 10 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Medica medicaid managed care plan facility · fee schedule · outpatient | $35 | $35 | — | — | — | $35 – $35 |
| 2 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $35 | $35 | — | — | — | $35 – $35 |
| 3 | Medica medicare managed care plan facility · fee schedule · outpatient | $64 | $64 | — | — | — | $64 – $64 |
| 4 | Aetna medicare managed care plan facility · fee schedule · outpatient | $96 | $96 | — | — | — | $96 – $96 |
| 5 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 6 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 7 | Medica all commercial plans facility · fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 8 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $131 | $131 | $19 | 15% | — | $112 – $150 |
| 9 | Aetna all commercial plans facility · fee schedule · outpatient | $136 | $136 | $36 | 26% | — | $101 – $172 |
| 10 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $188 | $188 | — | — | — | $188 – $188 |
Last updated: Mar 1, 2026
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