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/12-2.00d
Cedar Rapids, IA
See all hospitals reporting HCPCS V2103 →Price type
St Luke's Methodist Hospital’s median price of $43 is 11% below the median hospital's median price ($48), higher than 20% of the 734 hospitals reporting HCPCS V2103. 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, 17 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 | UnitedHealthcare hmo fee schedule · both | $20 | $20 | — | — | — | $20 – $20 |
| 2 | UnitedHealthcare ppo fee schedule · both | $20 | $20 | — | — | — | $20 – $20 |
| 3 | Wellmark commercial fee schedule · both | $37 | $37 | — | — | — | $37 – $37 |
| 4 | Wellmark hmo fee schedule · both | $37 | $37 | — | — | — | $37 – $37 |
| 5 | Wellmark ppo fee schedule · both | $37 | $37 | — | — | — | $37 – $37 |
| 6 | Aetna medicare advantage case rate · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 7 | Molina medicare advantage case rate · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 8 | Wellmark medicare advantage case rate · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 9 | Humana medicare advantage case rate · outpatient | $43 | $43 | — | — | — | $43 – $43 |
| 10 | UnitedHealthcare medicare advantage case rate · outpatient | $43 | $43 | — | — | — | $43 – $43 |
| 11 | Aetna hmo fee schedule · both | $46 | $46 | — | — | — | $46 – $46 |
| 12 | Aetna ppo fee schedule · both | $46 | $46 | — | — | — | $46 – $46 |
| 13 | UnitedHealthcare hmo fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 14 | UnitedHealthcare ppo fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 15 | Aetna hmo fee schedule · outpatient | $76 | $76 | — | — | — | $76 – $76 |
| 16 | Aetna ppo fee schedule · outpatient | $76 | $76 | — | — | — | $76 – $76 |
| 17 | Cigna commercial fee schedule · both | $78 | $78 | — | — | — | $78 – $78 |
Last updated: Jan 28, 2026
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.