• Cash Pay Invoice

    1515 River Park Drive, Suite 100 • Sacramento, CA 95815 • 916-649-1515
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Categories:All
    All
    Office Visits
    Testing
    Office Procedures
    Lasers
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                                                                                                Office Visits
                                                                                                New Patient Consultation

                                                                                                Cataract, Cornea or Glaucoma Consultation

                                                                                                $400$400
                                                                                                  
                                                                                                New Patient Consultation

                                                                                                Pterygium Consultation

                                                                                                $200$200
                                                                                                  
                                                                                                New Patient Optometrist Consultation
                                                                                                $125$125
                                                                                                  
                                                                                                Existing Patient Comprehensive Exam
                                                                                                $125$125
                                                                                                  
                                                                                                Brief Exam
                                                                                                $75$75
                                                                                                  
                                                                                                Refractive Surgery Consultation

                                                                                                Consultation for LASIK or PRK

                                                                                                $100$100
                                                                                                  
                                                                                                Refractive Lens Exchange Consultation
                                                                                                $400$400
                                                                                                  
                                                                                                Testing
                                                                                                A-Scan
                                                                                                $125$125
                                                                                                  
                                                                                                Corneal Topography
                                                                                                $100$100
                                                                                                  
                                                                                                Endothelial Count
                                                                                                $100$100
                                                                                                  
                                                                                                Fundus Photography
                                                                                                $100$100
                                                                                                  
                                                                                                Gonio
                                                                                                $40$40
                                                                                                  
                                                                                                OCT
                                                                                                $100$100
                                                                                                  
                                                                                                Pachymetry
                                                                                                $40$40
                                                                                                  
                                                                                                Pentacam
                                                                                                $100$100
                                                                                                  
                                                                                                Refraction
                                                                                                $50$50
                                                                                                  
                                                                                                Slit Lamp Photos
                                                                                                $40$40
                                                                                                  
                                                                                                Visual Field
                                                                                                $100$100
                                                                                                  
                                                                                                Office Procedures
                                                                                                AM Graft/Prokera
                                                                                                $1,430$1,430
                                                                                                  
                                                                                                Blephex
                                                                                                $300$300
                                                                                                  
                                                                                                Chalazion

                                                                                                One Location

                                                                                                $215$215
                                                                                                  
                                                                                                Chalazion

                                                                                                Multiple Locations

                                                                                                $265$265
                                                                                                  
                                                                                                Chelation EDTA
                                                                                                $500$500
                                                                                                  
                                                                                                Conjunctival Biopsy
                                                                                                $230$230
                                                                                                  
                                                                                                Conjunctival Excision < 1 cm
                                                                                                $305$305
                                                                                                  
                                                                                                Conjunctival Excision > 1 cm
                                                                                                $420$420
                                                                                                  
                                                                                                Conjunctivoplasty
                                                                                                $215$215
                                                                                                  
                                                                                                Corneal Cultures (scraping)
                                                                                                $150$150
                                                                                                  
                                                                                                Durysta
                                                                                                $2,500$2,500
                                                                                                  
                                                                                                Epilation Ellman
                                                                                                $170$170
                                                                                                  
                                                                                                Epilation Forceps
                                                                                                $45$45
                                                                                                  
                                                                                                Eyelid Biopsy
                                                                                                $230$230
                                                                                                  
                                                                                                Punctal Plug
                                                                                                $150$150
                                                                                                  
                                                                                                Punctual Cautery/Snip
                                                                                                $150$150
                                                                                                  
                                                                                                Punctual Irrigation
                                                                                                $170$170
                                                                                                  
                                                                                                Removal of Foreign Body
                                                                                                $100$100
                                                                                                  
                                                                                                SK (Superficial Keratectomy)
                                                                                                $880$880
                                                                                                  
                                                                                                Tarsorrhaphy

                                                                                                Permanent

                                                                                                $600$600
                                                                                                  
                                                                                                Tarsorrhaphy

                                                                                                Temporary

                                                                                                $230$230
                                                                                                  
                                                                                                Lasers
                                                                                                SLT
                                                                                                $500$500
                                                                                                  
                                                                                                YAG Capsulotomy
                                                                                                $430$430
                                                                                                  
                                                                                                YAG Iridotomy
                                                                                                $450$450
                                                                                                  
                                                                                                Total
                                                                                                $0.00$0.00
                                                                                              • Total Amount Due
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