| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $52.50 | $67.03 | $100.27 | |
United
| Facility | $1,011.00 | $1,011.00 | $1,861.00 |
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 |
|---|---|---|---|---|---|
Medica
| Facility | $52.50 | $67.03 | $100.27 | |
United
| Facility | $1,011.00 | $1,011.00 | $1,861.00 |