| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $61.18 | $94.45 | $120.90 | |
United
| Facility | $1,150.00 | $1,150.00 | $1,150.00 |
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 | $61.18 | $94.45 | $120.90 | |
United
| Facility | $1,150.00 | $1,150.00 | $1,150.00 |