| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.68 | $158.00 | $241.71 | |
Health Alliance Plan
| Professional | $112.68 | $112.68 | $241.71 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |
Vision supply, accessory and/or service component of another HCPCS vision code
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.68 | $158.00 | $241.71 | |
Health Alliance Plan
| Professional | $112.68 | $112.68 | $241.71 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |