| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 99211 | REM/ADJ DEV/CATH ONLY EP | $7,039 [source] | gross_charge | 2 weeks ago |
| 99212 | OP VISIT LEVEL 2 EST | $1,183 [source] | gross_charge | 2 weeks ago |
| 99213 | OP VISIT LEVEL 3 EST | $1,768 [source] | gross_charge | 2 weeks ago |
| 99214 | OP VISIT LEVEL 4 EST | $6,386 [source] | gross_charge | 2 weeks ago |
| C1713 | IMPL SAC JNT FUSN SYMTR | $29,060 [source] | gross_charge | 2 weeks ago |
| C1725 | CATH ULTSND IVL 6X60MM | $15,342 [source] | gross_charge | 2 weeks ago |
| C1776 | LINER HIP LT CSTM SZ26 | $39,216 [source] | gross_charge | 2 weeks ago |
| C1821 | IMPLNT SPN 16MM | $21,230 [source] | gross_charge | 2 weeks ago |
| C1874 | STENT GRAFT 37X37174MM | $58,105 [source] | gross_charge | 2 weeks ago |
| C1876 | STENT DVTR FLW 4.5X17MM | $40,133 [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 |