Single-vision spherocylinder eyeglass lens at St Luke's Methodist Hospital

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/2.12-4d

Cedar Rapids, IA

See all hospitals reporting HCPCS V2104 →

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Pricing by billing methodology

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How this price compares nationally

St Luke's Methodist Hospital’s median price of $47 is 13% below the median hospital's median price ($54), higher than 20% of the 732 hospitals reporting HCPCS V2104. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS V2104 at St Luke's Methodist Hospital

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	$23	$23	—	—	—	$23 – $23
2	UnitedHealthcare ppo fee schedule · both	$23	$23	—	—	—	$23 – $23
3	Wellmark commercial fee schedule · both	$41	$41	—	—	—	$41 – $41
4	Wellmark hmo fee schedule · both	$41	$41	—	—	—	$41 – $41
5	Wellmark ppo fee schedule · both	$41	$41	—	—	—	$41 – $41
6	Aetna medicare advantage case rate · outpatient	$46	$46	—	—	—	$46 – $46
7	Molina medicare advantage case rate · outpatient	$46	$46	—	—	—	$46 – $46
8	Wellmark medicare advantage case rate · outpatient	$46	$46	—	—	—	$46 – $46
9	Humana medicare advantage case rate · outpatient	$47	$47	—	—	—	$47 – $47
10	UnitedHealthcare medicare advantage case rate · outpatient	$47	$47	—	—	—	$47 – $47
11	Aetna hmo fee schedule · both	$51	$51	—	—	—	$51 – $51
12	Aetna ppo fee schedule · both	$51	$51	—	—	—	$51 – $51
13	UnitedHealthcare hmo fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
14	UnitedHealthcare ppo fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
15	Aetna hmo fee schedule · outpatient	$84	$84	—	—	—	$84 – $84
16	Aetna ppo fee schedule · outpatient	$84	$84	—	—	—	$84 – $84
17	Cigna commercial fee schedule · both	$86	$86	—	—	—	$86 – $86

Last updated: Jan 28, 2026

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