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Senate Bill 65

SENATE Bill 65

Summary of Projected Direct-Payer (i.e. without insurance) Costs for Common Services at EAGLE VISION & EYE CLINIC, PC 01/01/2018

Please note: The price for any given service is only an estimate and the actual charges are dependent on circumstances at the time a service is rendered.

1- Comprehensive Eye Exam Established Patient CPT Code: 92014

Price: $139.00 (Plus refraction cost of $29.00)

2- Comprehensive Eye Exam New Patient CPT Code: 92004

Price: $169.00 (Plus refraction cost of $29.00)

3- Refraction CPT Code: 92015

Price: $29.00

4- Office Visit - Level II Established Patient CPT Code: 99212

Price: $62.00

5- Office Visit - Level II New Patient CPT Code: 99202

Price: $106.00

6- Office Visit - Level III Established Patient CPT Code: 99213

Price: $103.00

7- Office Visit - Level III New Patient CPT Code: 99203

Price: $154.00

8- Office Visit - Level IV Established CPT Code: 99214

Price: $153.00

9- Office Visit - Level IV New Patient CPT Code: 99204

Price: $235.00

10- Contact Lens Office Visit CPT Code: 92310

Price: $46.00

11- Optomap Screening Photos CPT Code: S9986

Price: $46.00

12- OCT Optic Nerve Test CPT Code: 92133

Price: $65.00

13- OCT Retinal Test CPT Code: 92134

Price: $65.00

14- Visual Fields Comprehensive CPT Code: 92083

Price: $92.00

15- Pachymetry CPT Code: 76514

Price: $22.00

16- Corneal Topography CPT Code: 92025

Price: $54.00

17- Gonioscopy CPT Code: 92020

Price: $39.00

Patients covered by health insurance, are strongly encouraged to consult with their health insurer to determine accurate information about their financial responsibility for any health care service provided by this office. If you are not covered by health
insurance, you are strongly encouraged to contact our billing office at (303-651-2020) to discuss payment options prior to receiving
service from a provider in this office since posted healthcare prices may not reflect the actual amount of your responsibility.