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 sphcy bifocal 4.00d/2.1
Cedar Rapids, IA
See all hospitals reporting HCPCS V2204 →Price type
St Luke's Methodist Hospital’s median price of $69 is 6% below the median hospital's median price ($73), higher than 26% of the 732 hospitals reporting HCPCS V2204. 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 | $33 | $33 | — | — | — | $33 – $33 |
| 2 | UnitedHealthcare ppo fee schedule · both | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Wellmark commercial fee schedule · both | $59 | $59 | — | — | — | $59 – $59 |
| 4 | Wellmark hmo fee schedule · both | $59 | $59 | — | — | — | $59 – $59 |
| 5 | Wellmark ppo fee schedule · both | $59 | $59 | — | — | — | $59 – $59 |
| 6 | Aetna medicare advantage case rate · outpatient | $67 | $67 | — | — | — | $67 – $67 |
| 7 | Molina medicare advantage case rate · outpatient | $67 | $67 | — | — | — | $67 – $67 |
| 8 | Wellmark medicare advantage case rate · outpatient | $67 | $67 | — | — | — | $67 – $67 |
| 9 | Humana medicare advantage case rate · outpatient | $69 | $69 | — | — | — | $69 – $69 |
| 10 | UnitedHealthcare medicare advantage case rate · outpatient | $69 | $69 | — | — | — | $69 – $69 |
| 11 | Aetna hmo fee schedule · both | $73 | $73 | — | — | — | $73 – $73 |
| 12 | Aetna ppo fee schedule · both | $73 | $73 | — | — | — | $73 – $73 |
| 13 | UnitedHealthcare hmo fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 14 | UnitedHealthcare ppo fee schedule · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 15 | Aetna hmo fee schedule · outpatient | $121 | $121 | — | — | — | $121 – $121 |
| 16 | Aetna ppo fee schedule · outpatient | $121 | $121 | — | — | — | $121 – $121 |
| 17 | Cigna commercial fee schedule · both | $125 | $125 | — | — | — | $125 – $125 |
Last updated: Jan 28, 2026
See Bifocal eyeglass lens with sphere and cylinder correction pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.