| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.20 | $112.20 | $239.88 | |
Medica
| Facility | $27.54 | $112.20 | $223.87 | |
Wellmark
| Professional | $107.15 | $107.15 | $107.15 |
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 | $112.20 | $112.20 | $239.88 | |
Medica
| Facility | $27.54 | $112.20 | $223.87 | |
Wellmark
| Professional | $107.15 | $107.15 | $107.15 |