| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 99211 | OP VISIT LEVEL 1 EST | $589 [source] | gross_charge | 1 month ago |
| 99212 | OP VISIT LEVEL 2 EST | $783 [source] | gross_charge | 1 month ago |
| 99213 | OP VISIT LEVEL 3 EST | $1,037 [source] | gross_charge | 1 month ago |
| 99214 | OP VISIT LEVEL 4 EST | $1,296 [source] | gross_charge | 1 month ago |
| C1713 | ASSEMBLY ORTH BSPLT | $19,455 [source] | gross_charge | 1 month ago |
| C1725 | CATH PTA 6X100MM 135CM | $5,882 [source] | gross_charge | 1 month ago |
| C1776 | COMPONENT FEM C LT KN | $28,433 [source] | gross_charge | 1 month ago |
| C1821 | IMPLNT SPN 10MM | $21,230 [source] | gross_charge | 1 month ago |
| C1874 | GRFT STENT 14-32X103MM | $28,987 [source] | gross_charge | 1 month ago |
| C1876 | STENT CLN 22X60MM 270CM | $9,459 [source] | gross_charge | 1 month ago |
| V2632 | LENS IOL DIOP NTRL 19.0 | $565 [source] | gross_charge | 1 month ago |
| V2787 | Astigmatism correcting function of intraocular lens * | $588 [source] | — | 4 years ago |