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
$15
Median
$15
High
$54
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
17 hospitals; the 90th percentile is 5.0× 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.
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17 hospital rates
iThe hospitals that file a Medicaid 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 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 2 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 5 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 6 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 7 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 8 | Greater Baltimore Medical Center Towson, MD professional · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 9 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 10 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 11 | SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 12 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 13 | St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 14 | Ste. Genevieve County Memorial Hospital Ste. Genevieve, MO percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 15 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 16 | UMass Memorial Medical Center MA 01605; 157 Union Street Marlborough, MA percent of total billed charges · bothfrom % of charges | 2 | $54 | $54 | $17 | 32% | — | $37 – $71 |
| 17 | WILLITS HOSPITAL INC Willits, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
← Payers reporting CPT 99177 · Snapshot 20261111T120946Z-9134e7f7