| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $61.66 | $77.62 | $120.23 | |
Wellcare
| Facility | $616.60 | $616.60 | $616.60 |
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 |
|---|---|---|---|---|---|
Medcost
| Facility | $61.66 | $77.62 | $120.23 | |
Wellcare
| Facility | $616.60 | $616.60 | $616.60 |