| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.00 | $100.00 | $1,000.00 | |
Medica
| Professional | $87.98 | $87.98 | $87.98 |
Not Otherwise Classified Single Vision Lens
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.00 | $100.00 | $1,000.00 | |
Medica
| Professional | $87.98 | $87.98 | $87.98 |