Category Procedure Code Cash Price After 60% Prompt Pay Discount
Diagnostic B Scan Ultrasound 76512 $220.74 $88.30
Diagnostic Gonioscopy 92020 $61.64 $24.66
Diagnostic Visual Field 92083 $155.04 $62.02
Diagnostic OCT Glaucoma 92133 $102.84 $41.14
Diagnostic OCT Retina 92134 $105.32 $42.13
Diagnostic Fluorescein Angioscopy 92230 $131.54 $52.62
Diagnostic Fluorescein Angiography 92235 $264.92 $105.97
Diagnostic ICG Angiography 92240 $493.56 $197.42
Diagnostic Fundus Photography 92250 $168.92 $67.57
Diagnostic External Photos 92285 $50.88 $20.35
Exam Eye Code – New Patient – Intermediate 92002 $189.22 $75.69
Exam Eye Code – New Patient – Complete 92004 $342.84 $137.14
Exam Eye Code – Established Patient Intermediate Eye Exam 92012 $199.52 $79.81
Exam Eye Code – Established Patient Subsequent Eye Exam 92014 $286.98 $114.79
Exam Initial Ophthalmoscopy 92225 $61.52 $24.61
Exam Subsequent Ophthalmology 92226 $56.22 $22.49
Exam Post Operative Visit 99024 $0.00 $0.00
Exam E&M Code – New Patient – Extended 99202 $167.92 $67.17
Exam E&M Code – New Patient – Detailed 99203 $241.58 $96.63
Exam E&M Code – New Patient – Comprehensive 99204 $363.88 $145.55
Exam E&M Code – New Patient – Complex 99205 $448.96 $179.58
Exam E&M Code – Established Patient – Problem Focused 99212 $99.76 $39.90
Exam E&M Code – Established Patient – Moderate 99213 $163.30 $65.32
Exam E&M Code – Established Patient – Detailed 99214 $238.80 $95.52
Exam E&M Code – Established Patient – Comprehensive 99215 $317.96 $127.18
Fee Rebilling Copayment   $10.00 $8.00
Fee Collection Surcharge   $200.00 $160.00
Laser Laser Repair of Retinal Detachment 67105 $1,671.76 $668.70
Laser Prophylaxis of Retinal Detachment 67145 $1,222.02 $488.81
Laser Destruction of Retinal Lesion – Focal 67210 $1,202.84 $481.14
Laser Destruction of CNV 67220 $1,253.02 $501.21
Laser Destruction of Localized Lesion PDT 67221 $665.82 $266.33
Laser Destruction of Localized Lesion PDT OU 67225 $65.44 $26.18
Laser Destruction of Extensive of Progressive Retinopathy 67227 $1,389.76 $555.90
Laser Panretinal Photocoagulation 67228 $2,290.90 $916.36
Laser Photocoagulation for Preterm Infant 67229 $2,609.12 $1,043.65
Laser Unlisted Procedure (PDT) 67229 $2,609.12 $1,043.65
Office Procedure Removal of foreign body, external eye, conjunctival superficial 65205 $128.80 $51.52
Office Procedure Removal of foreign body, external eye, conjunctival embedded 65210 $159.68 $63.87
Office Procedure Removal of foreign body, corneal, without slit lamp 65220 $132.58 $53.03
Office Procedure Corneal Foreign Body Removed 65222 $156.00 $62.40
Office Procedure AC Tap Diagnostic 65800 $274.62 $109.85
Office Procedure AC Injection 66020 $439.82 $175.93
Office Procedure Intravitreal Injection 67028 $231.68 $92.67
Office Procedure Pneumatic Retinopexy 67110 $2,015.88 $806.35
Office Procedure Cryopexy for retinal detachment prophylaxis 67141 $1,229.64 $491.86
Office Procedure Retrobulbar Injection 67500 $172.84 $69.14
Office Procedure Subtenon’s Injection 67515 $223.30 $89.32
Office Procedure Correction of trichiasis; epilation, by forceps only 67820 $115.18 $46.07
Office Procedure Subconjunctival Injection 68200 $95.68 $38.27
Office Procedure Bandage Contact Lens 92071 $74.56 $29.82
Surgery Cyclotherapy 66720 $1,111.68 $444.67
Surgery Pars Plana Lens Extraction 66852 $1,953.48 $781.39
Surgery Posterior Sclerotomy/Vitreous Aspiration 67015 $1,344.26 $537.70
Surgery Injection of Vitreous Substitute Inc Gas 67025 $1,713.18 $685.27
Surgery Vitrectomy 67036 $2,187.80 $875.12
Surgery Vitrectomy w/ Focal Endolaser 67039 $2,854.14 $1,141.66
Surgery Vitrectomy w/ Endolaser 67040 $3,239.90 $1,295.96
Surgery Vitrectomy w/ Removal of Preretinal Membrane 67041 $3,003.18 $1,201.27
Surgery Vitrectomy w/ Removal of Membrane of Retina (internal limiting membrane) 67042 $3,421.10 $1,368.44
Surgery Retinal Cryopexy 67101 $1,846.82 $738.73
Surgery Scleral Buckle 67107 $2,806.32 $1,122.53
Surgery Scleral Buckle w/ Vitrectomy 67108 $3,648.60 $1,459.44
Surgery Repair of Complex Retinal Detachment 67113 $3,955.86 $1,582.34
Surgery Removal of Scleral Buckle 67120 $1,563.34 $625.34

 

 

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