Single-vision eyeglass lens, plano to ±4.00 diopter sphere at Fairview Maple Grove Surgery Center

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

Spherocylindr 4.00d/12-2.00d

Maple Grove, MN

See all hospitals reporting HCPCS V2103 →

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $54 is 12% above the median hospital's median price ($48), higher than 66% of the 734 hospitals reporting HCPCS V2103. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS V2103 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 5 payers, 18 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	Blue Cross Blue Shield federal fee schedule · outpatient	$40	$40	—	—	—	$40 – $40
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$41	$41	—	—	—	$41 – $41
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$41	$41	—	—	—	$41 – $41
4	Blue Cross Blue Shield federal fee schedule · both	$44	$44	—	—	—	$44 – $44
5	Blue Cross Blue Shield commercial fee schedule · both	$44	$44	—	—	—	$44 – $44
6	Medica ma non-snp fee schedule · both	$50	$50	—	—	—	$50 – $50
7	Medica ma snp fee schedule · both	$50	$50	—	—	—	$50 – $50
8	Medica prime solution fee schedule · both	$50	$50	—	—	—	$50 – $50
9	Medica vantage fee schedule · both	$50	$50	—	—	—	$50 – $50
10	Cigna commercial fee schedule · both	$61	$61	$5	9%	—	$56 – $67
11	Ucare ifp with fairview fee schedule · outpatient	$83	$83	—	—	—	$83 – $83
12	Medica bold fee schedule · both	$86	$86	—	—	—	$86 – $86
13	UnitedHealthcare commercial fee schedule · both	$87	$87	—	—	—	$87 – $87
14	Medica choice without / elect fee schedule · both	$96	$96	—	—	—	$96 – $96
15	Medica city of st paul / essential uplan fee schedule · both	$96	$96	—	—	—	$96 – $96
16	Medica choice with fee schedule · both	$99	$99	—	—	—	$99 – $99
17	Ucare ifp fee schedule · outpatient	$110	$110	—	—	—	$110 – $110
18	Cigna commercial fee schedule · outpatient	$129	$129	$11	9%	—	$118 – $140

Last updated: May 18, 2026

Compare to other hospitals

See Single-vision eyeglass lens, plano to ±4.00 diopter sphere pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.