What it does

The in-game text is "Augments a Rare item with a new random modifier". Rare items can hold up to six random modifiers, so an Exalted Orb only works while at least one slot is free.

How players use it

It fills the fifth and sixth slots on a rare that already has four good modifiers. Omen of Greater Exaltation makes the next Exalted Orb add two modifiers at once, and the Sinistral and Dextral Exaltation omens force the new modifier to be a prefix or a suffix.

Greater and Perfect versions

Greater and Perfect Exalted Orbs do the same job with a minimum modifier level of 35 or 50 on the new modifier.