| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $68.86 | $94.45 | $248.15 | |
Providence
| Facility | $61.33 | $104.68 | $248.15 |
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $68.86 | $94.45 | $248.15 | |
Providence
| Facility | $61.33 | $104.68 | $248.15 |