SCCB Medical Fees
CPT CODE |
DESCRIPTION OF SERVICE |
FEE |
|
794556510300 |
Enucleation of eye W/implant, muscle not attached to implant |
$531.81 |
|
|
|
|
794556510500 |
Enucleation of eye w/implant, muscles attached to implant |
$584.67 |
|
|
|
|
794556542000 |
Cornea, Excision or transposition of Pterygium; without graft |
$371.58 |
|
|
|
794556573000 |
Keratoplasty, Penetrating (Non-Aphakia |
$823.38 |
|
|
|
|
794556575500 |
Keratoplasty, Penetrating (in pseudophakia? |
$833.19 |
|
|
|
794556585000 |
Laser Trabeculoplasty; One or more |
$576.17 |
|
|
|
794556617000 |
Trabeculectomy (Surgical Filtering) |
$789.14 |
|
|
|
794556618000 |
Aqueous Shunt to extra ocular reservoir |
$788.06 |
|
|
|
794556663000 |
Iridectomy; sector for Glaucoma |
$377.68 |
|
|
|
794556682100 |
Yag Laser – one or more sessions |
$216.85 |
|
|
|
|
794556698200 |
Extracapsular Cataract Extraction lens W/IOL Complex |
$726.83 |
|
|
|
794556698400 |
Extracapsular Cataract Extraction W/IOL |
$519.64 |
|
|
|
|
794556702800 |
Intra Vitrealm Injection or Pharmacologic Agent |
$150.96 |
|
|
|
|
794556703600 |
Vitrectomy, Mechanical, Pars Plana Approach |
$652.01 |
|
|
|
794556703900 |
Vitrectomy, W/Focal Endolaser |
$837.28 |
|
|
|
794556704000 |
Vitrectomy W/Endolaser Pan Retinal |
$965.32 |
|
|
|
|
794556704100 |
Vitrectomy W/removal of preretinal cellular membrane |
$761.51 |
|
|
|
794556704200 |
Vitrectomy W/removal of internal limiting membrane |
$871.56 |
|
|
|
|
794556704300 |
Vitrectomy W/removal of sub-retinal membrane |
$914.97 |
|
|
|
|
794556710800 |
Sclera Buckling W/Vitrectomy W-WO Air/Gas |
$1,086.56 |
|
|
|
|
794556711200 |
Retinal repair by Sclera Bucking or Vitrectomy |
$892.39 |
|
|
|
|
794556711300 |
Retina Repair of complex retinal detachment |
$915.70 |
794556721000 |
Photocoagulation, Laser or Xenon ARC, Focal |
$468.80 |
|
|
|
794556722100 |
Photo Dynamic Therapy |
$220.40 |
|
|
|
|
794556722700 |
Destruction of extensive or progressive retinopathy |
$409.97 |
|
|
|
|
794556722800 |
Photocoagulation, Pan Retina (PRP) (up to 6 months) |
$734.85 |
|
|
|
794557651200 |
“B” Scan (with or without Superimposed non-quantitative A-Scan) |
$86.62 |
|
|
|
794557651300 |
Anterior segment ultrasound, “B” Scan |
$71.73 |
|
|
|
794557651400 794557651426 |
Corneal Pachymetry, unilateral or bilateral |
$9.51 |
794557651900 |
Ophthalmic ”A” Scan |
$60.40 |
|
|
|
794559200200 |
Ophthalmological services (new patient) |
$54.47 |
|
|
|
794559200400 |
Comprehensive Eye Exam – New patient |
$98.05 |
|
|
|
794559201200 |
Intermediate Exam Established Patient |
$49.24 |
|
|
|
|
794559201400 |
Comprehensive Exam, established patient |
$73.14 |
|
|
|
794559201500 |
Determination of Refractive State |
$48.56 |
|
|
|
794559202000 |
Gonioscopy (not part of exam) |
$20.20 |
|
|
|
794559208300 |
Goldmann Visual Fields |
$57.46 |
|
|
|
794559213500 |
Scanning Computerized Ophthalmic (OCT) - Interpretation |
$33.38 |
|
|
|
794559213600 |
Master A-Scan Power Calculation |
$63.60 |
|
|
|
794559223500 |
Flourescein Angiogram W/Photography Interpretation |
$98.81 |
|
|
|
794559225000 |
Fundus Photography |
$56.42 |
|
|
|
794559921200 |
Level II Follow Up; Establish Patient |
$29.15 |
|
|
|
794559921300 |
Level III Follow Up; Established Patient |
$48.12 |
|
|
|
794559921400 |
Level IV Follow Up; Established Patient |
$72.95 |
|
|
|
794559921500 |
Level V Follow Up; Established Patient |
$98.72 |
|
|
|
794559924300 |
Initial Office Consultation |
$97.81 |
|
|
|
7945599244 00 |
Initial Office Consultation |
$144.87 |
