| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $90.06 | $174.31 | $225.10 | |
Cigna
| Professional | $104.60 | $104.60 | $104.60 | |
United
| Professional | $108.72 | $128.25 | $213.75 |
Contact Lens Hydrophilic Toric Or Prism Ballast Per Lens (Special Coverage Instructions Apply. See Cim: 45-7 65-1)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $90.06 | $174.31 | $225.10 | |
Cigna
| Professional | $104.60 | $104.60 | $104.60 | |
United
| Professional | $108.72 | $128.25 | $213.75 |