Summary of Projected Direct-Payer (i.e. without insurance) Costs for Common Services at EAGLE VISION & EYE CLINIC, PC
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.
FEE SCHEDULE
EXAMS
| COMPREHENSIVE EXAM w/Refraction - ESTABLISHED (92014,92015) | $188.00 |
| COMPREHENSIVE EXAM w/Refraction - NEW (92004,92015) | $218.00 |
OFFICE VISITS
| NEW PATIENTS | ESTABLISHED PATIENTS |
| E/M 1 | 99201 . . . . . $61.00 | 99211 . . . . . $28.00 |
| E/M 2 | 99202 . . . . . $106.00 | 99212 . . . . . $62.00 |
| E/M 3 | 99203 . . . . . $154.00 | 99213 . . . . . $103.00 |
| E/M 4 | 99204 . . . . . $235.00 | 99214 . . . . . $153.00 |
| E/M 5 | 99205 . . . . . $295.00 | 99215 . . . . . $207.00 |
**Charge additional fee for refraction if done with office
visit.
CONTACT LENS RELATED FEES
| CL OFFICE VISIT/ ESTABLISHED (92310) | $59.00 |
| SCLERAL CL OFFICE VISIT | $68.00 |
| RLP – RGP | $58.00 |
| CORNEAL TOPOGRAPHY (92025) | $54.00 |
| CL POLISH (92325) | $25.00 |
RETINAL PHOTOGRAPHY
| OPTOMAP SCREENING PHOTOS (S9986) | $46.00 |
| OPTOMAP (1 EYE OR CHILD) | $39.00 |
| ANTERIOR SEGMENT PHOTOS (92285) | $29.00 per eye |
| OPTOMAP PHOTODOCUMENTATION PHOTOS (92250) | $112.00 |
VISUAL FIELDS
| FIELDS, LIMITED (92081) | $49.00 |
| FIELDS, INTERMEDIATE (92082) | $70.00 |
| FIELDS, & FDT COMPREHENSIVE (92083) | $92.00 |
| FIELDS, TAPED/UNTAPED (92083-22) | $112.00 |
MISCELLANEOUS FEES
| REFRACTION (92015) | $49.00 |
| SHIRMERS/RED THREAD TEST (95060) | $50.00 |
| READALYZER (92270) | $45.00 |
| MAXIVISION/MAXITEARS VITAMINS | $31.00 |
| SERIAL TONOMETRY (92100) | $114.00 |
| COLOR VISION (92283) | $81.00 includes E/M1 with doctor |
| GONIOSCOPY (92020) | $39.00 |
| OCT – Optic Nerve (92133) | $65.00 both eyes |
| OCT –Retinal (92134) | $65.00 both eyes |
| PACHYMETRY (76514) | $22.00 |
VISION THERAPY
| BASIC SKILLS EVALUATION (92060) | $131.00 |
| NON-STRABISMUS SESSION (92065) | $107.00 |
| STRABISMUS/AMBLYOPE EVALUATION(92060) | $138.00 |
| STRABISMUS/AMBLYOPIA SESSION (92065) | $113.00 |
| VT EQUIPMENT PACKET (99070) | $112.00 |
| PERCEPTUAL EVALUATION | $324.00 PLUS skills or strab eval fee |
| PERCEPTION PROGRESS CHECK (92065-52) | $102.00 |
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.
