| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $15.14 | $112.20 | $239.88 | |
Molina
| Professional | $1.45 | $2.09 | $95.50 | |
Providence
| Facility | $19.50 | $123.03 | $239.88 |
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 | $15.14 | $112.20 | $239.88 | |
Molina
| Professional | $1.45 | $2.09 | $95.50 | |
Providence
| Facility | $19.50 | $123.03 | $239.88 |