| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $714.80 | $2,910.09 | $4,835.85 |
Compl Oph Xm&Eval General Anes W/Wo Mnpj Globe
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $714.80 | $2,910.09 | $4,835.85 |