| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 29240 | Strap Shoulder LT * | $307 [source] | — | 4 years ago |
| 99211 | VISIT ESTABLISHED LEVEL 1 * | $65 [source] | — | 4 years ago |
| 99212 | VISIT ESTABLISHED LEVEL 2 * | $255 [source] | — | 4 years ago |
| 99213 | VISIT ESTABLISHED LEVEL 3 * | $211 [source] | — | 4 years ago |
| 99214 | VISIT ESTABLISHED LEVEL 4 * | $252 [source] | — | 4 years ago |
| V2632 | Posterior chamber intraocular lens * | $157 [source] | — | 4 years ago |
| V2787 | Astigmatism correcting function of intraocular lens * | $475 [source] | — | 4 years ago |