| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $38.90 | $158.49 | $158.49 | |
Providence
| Facility | $15.14 | $15.14 | $134.90 | |
Providence
| Professional | $100.00 | $100.00 | $100.00 |
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 | $38.90 | $158.49 | $158.49 | |
Providence
| Facility | $15.14 | $15.14 | $134.90 | |
Providence
| Professional | $100.00 | $100.00 | $100.00 |