| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 99211 | OP VISIT LEVEL 1 EST | $462 [source] | gross_charge | 2 weeks ago |
| 99212 | OP VISIT LEVEL 2 EST | $594 [source] | gross_charge | 2 weeks ago |
| 99213 | OP VISIT LEVEL 3 EST | $1,121 [source] | gross_charge | 2 weeks ago |
| 99214 | OP VISIT LEVEL 4 EST | $1,451 [source] | gross_charge | 2 weeks ago |
| C1713 | IMPLANT CRNL XL PEK CSTM | $58,120 [source] | gross_charge | 2 weeks ago |
| C1725 | CATH BLN PRPF 80MM 150CM | $23,383 [source] | gross_charge | 2 weeks ago |
| C1776 | CMPNT FEM KN RT SZ6 | $78,840 [source] | gross_charge | 2 weeks ago |
| C1821 | IMPLNT SPN 14MM | $21,230 [source] | gross_charge | 2 weeks ago |
| C1874 | STENT GRAFT 28X28X97MM | $53,746 [source] | gross_charge | 2 weeks ago |
| C1876 | DEVICE EMBL 20MM 4.5MM | $41,323 [source] | gross_charge | 2 weeks ago |
| V2787 | LENS IOL +20.5 DIOP 2.25 | $7,114 [source] | gross_charge | 2 weeks ago |
| V2632 | Posterior chamber intraocular lens * | $569 [source] | — | 4 years ago |