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
Spherocylindr 4.00d/2.12-4d
Edina, MN
See all hospitals reporting HCPCS V2104 →Price type
Fairview Health Services’s median price of $63 is 16% above the median hospital's median price ($54), higher than 79% of the 732 hospitals reporting HCPCS V2104. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 29 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 | Bcbs Mn pmap fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 2 | Bcbs Mn aware federal fee schedule · both | $45 | $45 | — | — | — | $45 – $45 |
| 3 | Bcbs Mn aware/blue plus fee schedule · both | $46 | $46 | — | — | — | $46 – $46 |
| 4 | Sanford Health Plan medicare advantage fee schedule · outpatient | $48 | $48 | — | — | — | $48 – $48 |
| 5 | UnitedHealthcare medicare advantage fee schedule · outpatient | $48 | $48 | — | — | — | $48 – $48 |
| 6 | WellCare medicare advantage fee schedule · outpatient | $48 | $48 | — | — | — | $48 – $48 |
| 7 | Ucare medicare advantage/msho fee schedule · outpatient | $48 | $48 | — | — | — | $48 – $48 |
| 8 | Bcbs Mn medicare advantage fee schedule · outpatient | $50 | $50 | — | — | — | $50 – $50 |
| 9 | Medica medicare advantage non-snp fee schedule · outpatient | $51 | $51 | — | — | — | $51 – $51 |
| 10 | Medica medicare advantage non-snp fee schedule · both | $51 | $51 | — | — | — | $51 – $51 |
| 11 | Bcbs Mn aware federal fee schedule · outpatient | $52 | $52 | — | — | — | $52 – $52 |
| 12 | Medica msho/medicare advantage snp fee schedule · both | $52 | $52 | — | — | — | $52 – $52 |
| 13 | Bcbs Mn aware/blue plus fee schedule · outpatient | $53 | $53 | — | — | — | $53 – $53 |
| 14 | Medica managed medicaid/accessability fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 15 | Medica msho/medicare advantage snp fee schedule · outpatient | $63 | $63 | — | — | — | $63 – $63 |
| 16 | Ucare individual and family with m health fairview fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 17 | Medica bold fee schedule · both | $89 | $89 | — | — | — | $89 – $89 |
| 18 | UnitedHealthcare commercial fee schedule · both | $94 | $94 | — | — | — | $94 – $94 |
| 19 | UnitedHealthcare core fee schedule · both | $94 | $94 | — | — | — | $94 – $94 |
| 20 | Medica vantage self insured fee schedule · both | $97 | $97 | — | — | — | $97 – $97 |
| 21 | Medica city of st. paul/essential-uplan fee schedule · both | $99 | $99 | — | — | — | $99 – $99 |
| 22 | Medica individual and family business except aco fee schedule · both | $99 | $99 | — | — | — | $99 – $99 |
| 23 | Medica choice fee schedule · both | $103 | $103 | — | — | — | $103 – $103 |
| 24 | Medica bold fee schedule · outpatient | $108 | $108 | — | — | — | $108 – $108 |
| 25 | Ucare individual and family fee schedule · outpatient | $110 | $110 | — | — | — | $110 – $110 |
Last updated: Feb 6, 2026
See Single-vision spherocylinder eyeglass lens pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.