Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Instrument Based Ocular Scr Bi W/Onsite Analysis
Low
$3
Average
$28
Median
$18
High
$66
Each hospital's average Amerihealth Caritas rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 9.6× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
33 hospital rates
iThe hospitals that file a Amerihealth Caritas rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 2 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 3 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 4 | Bayhealth Hospital, Sussex Campus Milton, DE fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 5 | Bayhealth Medical Center, Kent Campus Dover, DE fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 6 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $66 | $66 | — | — | — | $66 – $66 |
| 7 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $66 | $66 | — | — | — | $66 – $66 |
| 8 | Carolinas Medical Center Davidson, NC percent of total billed charges · outpatientfrom % of charges | 1 | $66 | $66 | — | — | — | $66 – $66 |
| 9 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $66 | $66 | — | — | — | $66 – $66 |
| 10 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 11 | Cheshire Medical Center Keene, NH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 12 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 13 | Henry Ford Health System West Bloomfield, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 14 | Henry Ford Health System West Bloomfield, MI professional · percent of total billed charges · outpatientfrom % of charges | 2 | $15 | $15 | — | — | — | $15 – $15 |
| 15 | Henry Ford Health System Plymouth, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 16 | Henry Ford Health System Plymouth, MI professional · percent of total billed charges · outpatientfrom % of charges | 2 | $15 | $15 | — | — | — | $15 – $15 |
| 17 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 18 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI professional · percent of total billed charges · outpatientfrom % of charges | 2 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 20 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI professional · percent of total billed charges · outpatientfrom % of charges | 2 | $15 | $15 | — | — | — | $15 – $15 |
| 21 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $14 | $14 | $0 | 3% | — | $14 – $15 |
| 22 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 23 | St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 24 | The Charlotte Mecklenburg Hospital Authority Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 25 | The Charlotte Mecklenburg Hospital Authority Kannapolis, NC percent of total billed charges · outpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
← Payers reporting CPT 99177 · Snapshot 20261111T120946Z-9134e7f7