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
Lens sphere trifocal 4.12-7.
Devils Lake, ND
See all hospitals reporting HCPCS V2301 →Price type
Altru Hospital Devils Lake’s median price of $105 is 2% below the median hospital's median price ($107), higher than 45% of the 731 hospitals reporting HCPCS V2301. 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.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Medica medicaid managed care plan facility · fee schedule · outpatient | $36 | $36 | — | — | — | $36 – $36 |
| 2 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $36 | $36 | — | — | — | $36 – $36 |
| 3 | Medica medicare managed care plan facility · fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 4 | Aetna medicare managed care plan facility · fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 5 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $105 | $105 | — | — | — | $105 – $105 |
| 6 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $105 | $105 | — | — | — | $105 – $105 |
| 7 | Medica all commercial plans facility · fee schedule · outpatient | $105 | $105 | — | — | — | $105 – $105 |
| 8 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $129 | $129 | $19 | 15% | — | $110 – $148 |
| 9 | Aetna all commercial plans facility · fee schedule · outpatient | $134 | $134 | $35 | 26% | — | $99 – $170 |
| 10 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $184 | $184 | — | — | — | $184 – $184 |
Last updated: Mar 1, 2026
See Trifocal spectacle lens, sphere power ±4.12 to ±7.00 diopters, per lens pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.