| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $53.70 | $70.79 | $165.96 | |
Medica
| Facility | $61.66 | $128.82 | $186.21 | |
Midlands
| Professional | $128.82 | $165.96 | $186.21 |
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 |
|---|---|---|---|---|---|
Hally Health
| Professional | $53.70 | $70.79 | $165.96 | |
Medica
| Facility | $61.66 | $128.82 | $186.21 | |
Midlands
| Professional | $128.82 | $165.96 | $186.21 |