0A~IDICODEC COSTN DOLLARSN FLATRATEN# INFORMALL-ISDOLLARSL.NAMEC/NAME2C)PERCOMC#TYPEC7UNITNL UNITTYPECVSCUTCWISNOTBILLL_ISTAXL`TAXNa IDMODIFIjIDMODIF2InISCANCELVSLrACTCOSTNs ISPRN1500L} P+92015 0.00 0.00 0.00FTREFRACTION (PVT) OFFICE VISITS 1.00 FF 0.000F 0.00F S+92002 0.00 0.00 0.00FTEYE EXAM - NEW LEVEL 2 OFFICE VISITS 1.00 FF 0.000F 0.00F Y+92004 0.00 0.00 0.00FTEYE EXAM - NEW LEVEL 4 OFFICE VISITS 1.00 FF 0.000F 0.00F [+92012 0.00 0.00 0.00FTEYE EXAM - EST LEVEL 2 OFFICE VISITS 1.00 FF 0.000F 0.00F ]+92014 0.00 0.00 0.00FTEYE EXAM - EST LEVEL 4 OFFICE VISITS 1.00 FF 0.000F 0.00F _+99201 0.00 0.00 0.00FTOFFICE VISIT - NEW LEVEL 1 OFFICE VISITS 1.00 FF 0.000F 0.00F a+99202 0.00 0.00 0.00FTOFFICE VISIT - NEW LEVEL 2 OFFICE VISIITS 1.00 FF 0.000F 0.00F c+99203 0.00 0.00 0.00FTOFFICE VISIT - NEW LEVEL 3 OFFICE VISITS 1.00 FF 0.000F 0.00F e+99204 0.00 0.00 0.00FTOFFICE VISIT - NEW LEVEL 4 OFFICE VISITS 1.00 FF 0.000F 0.00F g+99205 0.00 0.00 0.00FTOFFICE VISIT - NEW LEVEL 5 OFFICE VISITS 1.00 FF 0.000F 0.00F i+99211 0.00 0.00 0.00FTOFFICE VISIT - EST LEVEL 1 OFFICE VISITS 1.00 FF 0.000F 0.00F k+99212 0.00 0.00 0.00FTOFFICE VISIT - EST LEVEL 2 OFFICE VISITS 1.00 FF 0.000F 0.00F m+99213 0.00 0.00 0.00FTOFFICE VISIT - EST LEVEL 3 OFFICE VISITS 1.00 FF 0.000F 0.00F o+99214 0.00 0.00 0.00FTOFFICE VISIT - EST LEVEL 4 OFFICE VISITS 1.00 FF 0.000F 0.00F q+99215 0.00 0.00 0.00FTOFFICE VISIT - EST LEVEL 5 OFFICE VISITS 1.00 FF 0.000F 0.00F s+76514 0.00 0.00 0.00FTCORNEAL PACHYMETRY SPECIAL EXAMS 1.00 FF 0.000F 0.00F u+76516 0.00 0.00 0.00FTULTRASOUND SPECIAL EXAMS 1.00 FF 0.000F 0.00F w+92020 0.00 0.00 0.00FTGONIOSCOPY SPECIAL EXAMS 1.00 FF 0.000F 0.00F y+92060 0.00 0.00 0.00FTSENSRIMOTOR EXAM SPECIAL EXAMS 1.00 FF 0.000F 0.00F {+92083 0.00 0.00 0.00FTVISUAL FIELDS SPECIAL EXAMS 1.00 FF 0.000F 0.00F ~+92135 0.00 0.00 0.00FTOCT SPECIAL EXAMS 1.00 FF 0.000F 0.00F +92136 0.00 0.00 0.00FTIOL PROFESSIONAL COMPONENT SPECIAL EXAMS 1.00 FF 0.0005+I+F 0.00F +92070 0.00 0.00 0.00FTCONTACT LENS - THERAPEUTIC CONTACT LENSES 1.00 FF 0.000F 0.00F +92226 0.00 0.00 0.00FTBIOMICROSCOPY SPECIAL EXAMS 1.00 FF 0.000F 0.00F +92283 0.00 0.00 0.00FTCOLOR VISION - EXTENDED SPECIAL EXAMS 1.00 FF 0.000F 0.00F +92285 0.00 0.00 0.00FTOCULAR PHOTOGRAPHY SPECIAL EXAMS 1.00 FF 0.000F 0.00F +92025 0.00 0.00 0.00FTCORNEAL TOPOGRAPHY SPECIAL EXAMS 1.00 FF 0.000F 0.00F +92499 0.00 0.00 0.00FTCORNEAL TOPOGRAPHY SPECIAL EXAMS 1.00 FF 0.000F 0.00F +17000 0.00 0.00 0.00FTHYFRECATION MINOR SURGERY 1.00 FF 0.000F 0.00F +65222 0.00 0.00 0.00FTCORNEAL FB REMOVAL MINOR SURGERY 1.00 FF 0.000F 0.00F +65400 0.00 0.00 0.00FTLAMELLAR KERATECTOMY MAJOR SURGERY 1.00 FF 0.000F 0.00F +65420 0.00 0.00 0.00FTPTERYGIUM W/O GRAFT MAJOR SURGERY 1.00 FF 0.000F 0.00F +65426 0.00 0.00 0.00FTPTERYGIUM W/ GRAFT MAJOR SURGERY 1.00 FF 0.000F 0.00F +65430 0.00 0.00 0.00FTCORNEAL CULTURE/SCRAPING MINOR SURGERY 1.00 FF 0.000F 0.00F +65436 0.00 0.00 0.00FTREMOVE CORNEA EPITH/CHELATING MAJOR SURGERY 1.00 FF 0.000F 0.00F +65730 0.00 0.00 0.00FTCORNEAL TRANSPLANT - PHAKIC MAJOR SURGERY 1.00 FF 0.000F 0.00F +65750 0.00 0.00 0.00FTCORNEAL TRANSPLANT - APHAKIC MAJOR SURGERY 1.00 FF 0.000F 0.00F +65755 0.00 0.00 0.00FTCORNEAL TRANSPLANT - PSEUDOPHAKIC MAJOR SURGERY 1.00 FF 0.000F 0.00F +65855 0.00 0.00 0.00FTTRABECULOPLASTY ARGON MAJOR SURGERY 1.00 FF 0.000F 0.00F +66250 0.00 0.00 0.00FTREVISE OPERATIVE WOUND MAJOR SURGERY 1.00 FF 0.000F 0.00F +66761 0.00 0.00 0.00FTIRIDOTOMY - LASER MAJOR SURGERY 1.00 FF 0.000F 0.00F +66821 0.00 0.00 0.00FTYAG LASER CAPSULOTOMY MAJOR SURGERY 1.00 FF 0.000F 0.00F +66825 0.00 0.00 0.00FTREPOSITIONING OF IOL MAJOR SURGERY 1.00 FF 0.000F 0.00F +66982 0.00 0.00 0.00FTCATARACT - COMPLEX MAJOR SURGERY 1.00 FF 0.000F 0.00F +66983 0.00 0.00 0.00FTCATARACT W/ IOL 1 STAGE MAJOR SURGERY 1.00 FF 0.000F 0.00F +66984 0.00 0.00 0.00FTCATARACT W/ IOL 1-STAGE MAJOR SURGERY 1.00 FF 0.000F 0.00F +67700 0.00 0.00 0.00FTLID EXCISION AND DRAIN MINOR SURGERY 1.00 FF 0.000F 0.00F +67005 0.00 0.00 0.00FTVITRECTOMY ANTERIOR MAJOR SURGERY 1.00 FF 0.000F 0.00F +67875 0.00 0.00 0.00FTTARSORRHAPHY MINOR SURGERY 1.00 FF 0.000F 0.00F +67966 0.00 0.00 0.00FTLID REC ONSTRUCTION > 1/4 MAJOR SURGERY 1.00 FF 0.000F 0.00F +68020 0.00 0.00 0.00FTCONJUNCTIVAL CYST INCISION MINOR SURGERY 1.00 FF 0.000F 0.00F +68760 0.00 0.00 0.00FTPUNCTUM CARTERY MINOR SURGERY 1.00 FF 0.000F 0.00F +68761 0.00 0.00 0.00FTCLOSE PUNCTUM BY PLUG MINOR SURGERY 1.00 FF 0.000F 0.00F +68840 0.00 0.00 0.00FTNASO-LACRIMAL PROBE MINOR SURGERY 1.00 FF 0.000F 0.00F +99241 0.00 0.00 0.00FTCONSULT - OFFICE NEW/EST OFFICE VISITS 1.00 FF 0.000F 0.00F +99242 0.00 0.00 0.00FTCONSULT - OFFICE NEW/EST OFFICE VISITS 1.00 FF 0.000F 0.00F +99243 0.00 0.00 0.00FTCONSULT - OFFICE NEW/EST OFFICE VISITS 1.00 FF 0.000F 0.00F +99244 0.00 0.00 0.00FTCONSULT - OFFICE NEW/EST OFFICE VISITS 1.00 FF 0.000F 0.00F +99245 0.00 0.00 0.00FTCONSULT - OFFICE NEW/EST OFFICE VISITS 1.00 FF 0.000F 0.00F R92135 0.00 0.00 0.00FTOCT SPECIAL EXAMS 1.00 FF 0.000F 0.00F {66999 0.00 0.00 0.00FTLASIK SURGERY MAJOR SURGERY 1.00 FF 0.000F 0.00F {99241 0.00 0.00 0.00FTLASIK CONSULTATION OFFICE VISIT 1.00 FF 0.000F 0.00F {92326 0.00 0.00 0.00FTCONTACT LENS CONTACT LENSES 1.00 FF 0.000F 0.00F 67825 0.00 0.00 0.00FTEPILATION ELECTROLYSIS MINOR SURGERY 1.00 FF 0.000F 0.00F 12051 0.00 0.00 0.00FTLAYER CLOSURE OF WOUND (ME) MINOR SURGERY 1.00 FF 0.000F 0.00F